Inspection on 03/08/07 for Forest Green

This inspection was carried out on 3rd August 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Forest Green 15/11/06

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Forest Green 46 Park Road Berry Hill Coleford Gloucestershire GL16 7AG Lead Inspector Mr Richard Leech Key Unannounced Inspection 3 & 9th August 2007 10:15 rd Forest Green DS0000066989.V347787.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 Green DS0000066989.V347787.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 Green DS0000066989.V347787.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Forest Green Address 46 Park Road Berry Hill Coleford Gloucestershire GL16 7AG 01594 836866 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) www.brandontrust.org The Brandon Trust Mr Charles Patrick Bunn Care Home 5 Category(ies) of Learning disability (5), Physical disability (1), registration, with number Sensory impairment (1) of places Forest Green DS0000066989.V347787.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home providing personal care only- Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Learning disability- Code LD Physical disability- Code PD 2. Sensory impairment- Code SI The maximum number of service users who can be accommodated is 5. Date of last inspection 15th November 2006 Brief Description of the Service: Forest Green is a detached house providing care and accommodation for up to five adults with learning disabilities, some of whom may also have physical disabilities and sensory impairments. The home is situated near Coleford in Gloucestershire. The property has a basement, ground floor and first floor. There is a large garden. All service users are accommodated in single bedrooms on either the ground or first floor. At the time of the inspection there were five people living in the home. The Brandon Trust runs the home, having taken over from the previous service provider in April 2006. Prospective service users and others involved in their care are offered information about the home including copies of the Statement of Purpose and Service Users Guide. Up to date information about fee levels was not obtained during this visit. Forest Green DS0000066989.V347787.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection began on a Friday morning, lasting until early evening. A second visit was made on the following Thursday from mid morning to 14:00. The manager was present for the second visit. During the visits to the home all of the people living there were met with along with many of the staff team. All of the communal areas were checked, as well as some people’s bedrooms. Various records were looked at including examples of care plans, risk assessments, medication charts, training summaries and policies & procedures. Prior to the inspection the manager completed a pre-inspection questionnaire. Surveys were also distributed to people involved with service users’ care, resulting in some responses. What the service does well: People moving in have their needs assessed. This helps to ensure that the home will be able to meet these needs and provide appropriate care. The home has generally good systems for care planning and for assessing and managing risks. People are supported to make choices and to take risks as part of leading full lives and taking up different opportunities. People living in the home are supported to take part in activities that reflect their needs and interests, both in the home and the local community. They are also supported to stay in touch with family and friends. A varied and balanced menu is offered which takes into account people’s needs, choices and preferences. People’s personal care needs are met in a sensitive way which reflects people’s needs and preferences. The people living in the home are also supported to stay well by accessing healthcare services appropriate to their needs. The handling of medication in the home is generally good, although some aspects of practice could improve. People living in the home feel able to express concerns and dissatisfaction and are also asked what they think of the service. Staff listen and respond to this. There are a range of measures which help to protect the people living in the home from harm and abuse. Forest Green provides a homely, comfortable and spacious environment. Forest Green DS0000066989.V347787.R01.S.doc Version 5.2 Page 6 Staff are competent and skilled and are supported to access professional development opportunities. They receive training which is relevant to their roles and responsibilities. What has improved since the last inspection? What they could do better: The way that restrictions and limitations are documented could be improved so that the reasons are clear, and also to reflect some changes in the law that are about to come into force. Health Action Planning should be introduced as soon as possible in order to help promote people’s physical and mental health as much as possible. A number of the Trust’s policies and procedures are in need of review and update. The complaints procedure needs to include contact details for CSCI. Some aspects of the recording of significant purchases and financial transactions could be improved. Although the physical environment has greatly improved since the last inspection there are still a number of areas which need attention. This includes some rooms being repainted to make the décor fresher and brighter. Whilst the home was found to be clean and hygienic, some practices around food hygiene should be tightened up. Improvements could be made to some aspects of training provision. There was some feedback that the service would benefit from a more dynamic and creative approach, and through clearer direction and leadership. Practice needs to improve around fire safety. Forest Green DS0000066989.V347787.R01.S.doc Version 5.2 Page 7 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 Green DS0000066989.V347787.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 Green DS0000066989.V347787.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Satisfactory arrangements are in place around assessment and admission, helping to ensure that the service can meet the needs of people who move into the home. EVIDENCE: Since the last admission one person had moved into the home. Staff said that this had been an emergency admission. The person had moved in from hospital having previously been a resident at another service run by the Trust. They had required a ground floor bedroom and one had been available at Forest Green. Due to the circumstances of the admission the person had not visited the home before moving in. However, the manager and staff reported that members of the team from the person’s previous home had provided two weeks of intensive support (including overnight) in order to facilitate the transition. This is good practice. Forest Green DS0000066989.V347787.R01.S.doc Version 5.2 Page 10 Background information from the person’s former home was seen to be on file in Forest Green. The manager reported that the person’s care manager had been met with as soon as possible following this emergency admission. Staff in the home said that, although the admission had been very sudden, they had felt well supported and they had enough information to begin working with the person. They reported that the service user had settled in well and expressed confidence that the person’s needs could be met at Forest Green. The person’s care was looked at in some depth during the inspection, providing evidence that their needs were being met. There was evidence that their health had improved since moving in. The person indicated that they liked living in the home when asked. An up to date assessment of needs and care plan from the placing authority was seen on the person’s file. It was noted that the Trust’s policy about admissions dated from 2000. This therefore pre-dates the National Minimum Standards. Although it provides a reasonable framework, this should be reviewed and updated, including taking into account the relevant National Minimum Standards. Forest Green DS0000066989.V347787.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. A reasonable care-planning framework operates, helping to ensure that people’s needs are identified and met and that meaningful choices are offered. Practice around restrictions and best interests could be improved to reflect changes in legislation. Systems are in place for assessing and managing risks, promoting people’s safety in day-to-day life and when they participate in activities. EVIDENCE: Care plans for two people were looked at. These were seen to cover key areas such as personal care, activities, eating & drinking, routines and communication. There was reference to people’s choices, goals, rights and preferences. Plans also reminded staff about privacy and dignity issues when providing care and of the need to promote independence as far as possible. Forest Green DS0000066989.V347787.R01.S.doc Version 5.2 Page 12 There was evidence of reasonably regular review, although in some cases changes had been made to care plans with no date or author. Some plans were becoming difficult to read due to multiple handwritten additions. Some work had been done on identifying people’s likes and preferences. These were documented in ‘Essential Lifestyle Plans’. One person living in the home confirmed that this document had been discussed with them when asked. Conversations with staff provided evidence of knowledge of people’s support needs and care plans. There was discussion about total communication, including objects of reference, and whether there was potential to develop this aspect of practice further. In subsequent discussion the manager described plans for reinvigorating total communication practice in the home. Some staff felt that care plans should be more detailed and that reviews needed to be more regular. There was also some feeling that practice could vary between different team members to the point where it was inconsistent. For example, some reported that drinks in the evening (other than water) would be provided on request, or only at 20:00, depending on the staff on shift. Although no direct evidence of these kinds of variations was found, this could be a discussion point for the team. Care plans noted some restrictions, such as one person’s wardrobe being locked. Staff were able to describe the reason for this restriction, although the care plan gave the rationale simply as ‘institutional behaviour’. Another person was seen to be denied a request for tea, and was offered squash instead. This was in accordance with a care plan, although the plan did not clearly state the reasons for this limitation. The reason for such restrictions should be made more explicit in care plans or other documents making reference to limitations of freedom. The team should begin to adopt the approaches to capacity and best interests described in the Mental Capacity Act and accompanying code of practice and reflect this in documentation. Throughout the inspection people living in the home were seen being offered choices, such as about diet. Staff spoken with also described how they offered choices in day-to-day care, for example, around routines and choice of clothing. Daily records included many examples of people being offered choices in everyday life. They also noted people going to bed at different times of their choosing. Risk assessments for two people were checked. These covered significant risks, providing guidance about these were managed. Discussion with staff and checking daily records provided evidence that people were supported to take risks in daily life through taking part in activities in the home and community. Missing person’s protocols were seen in people’s files. Forest Green DS0000066989.V347787.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home are supported to take part in activities appropriate to their needs and interests, promoting their quality of life, although there may be potential for further development in some cases. Appropriate support is provided to enable people to maintain important relationships. People are included in the running of the home, helping them to feel valued. A varied and balanced menu is offered which takes into account people’s needs and preferences, promoting their enjoyment of food and mealtimes. EVIDENCE: Forest Green DS0000066989.V347787.R01.S.doc Version 5.2 Page 14 An activities schedule was seen on display in the dining area. Reference to people’s programmes was also seen in care plans. Activities for two people were checked in detail. One person had a wide range of activities noted. They described how they spent their time and expressed satisfaction with their activities. Staff spoken with felt that the person led a full life. A second person had no scheduled activities noted on the display board. Care plans described the kinds of activities that they enjoyed, such as going out for drives and having a drink or meal out. Daily records were checked for a period of 15 days in July 2007. According to these records the person had gone out from the home on only four of those days. Activities noted included going out for lunch, shopping and a daytrip to local beauty spot. Some staff spoken with felt that there was scope to improve activity provision for the person. There was evidence that the team was supporting them to broaden their activity programme, for example, going to a local chapel. They had also recently enjoyed a trip on a steam railway and had been on a bus. It was reported that the person also enjoyed staying at home and having quieter days, for example, watching TV or listening to music. Another person living in the home was asked about their activities and expressed satisfaction with how they spent their time. Staff described the holidays that people had taken recently. These were described as successful. One person had needed to cut short their time away due to adverse weather but another holiday was planned for them for later in the year. Some staff pointed out that the home was well located for local facilities and public transport networks. Some also commented that the people living in the home could be accessing the local community more. However, there was a feeling that this was already beginning to happen more, for example, with some people accessing local places of worship. Discussion with people living in the home and with staff provided evidence of people being supported to stay in contact with family and friends. During the visits people were seen moving freely around the home. The people living in the home were also seen to help with some domestic tasks. As mentioned, care planning files made reference to people’s rights. There were also notes about citizenship issues such as voting in elections. Staff were seen to explain what they were doing when providing support to the people living in the home in a respectful manner. Forest Green DS0000066989.V347787.R01.S.doc Version 5.2 Page 15 Examples of menus were seen, providing evidence of a reasonably balanced and varied diet. A four-week summer menu was in operation at the time. During the visits people were seen having breakfast and an evening meal. The atmosphere was relaxed, with people appearing to enjoy their meals. Food was attractively presented. Fresh fruit and vegetables were used. Some of the people living in the home were asked if they liked the food and replied that they did. They confirmed that they were offered choices of food and could have alternatives to what was on the menu if they wished. Care plans included reference to healthy eating and to issues around exercise and weight. However, according to records one person had last been weighed in February 2007. A fruit and vegetables diary was being completed but this was being filled in erratically. The manager reported that the person was being weighed by healthcare professionals as part of health promotion, though said that the information should be copied to the home’s records. Staff said that there was a takeaway night once a month. Forest Green DS0000066989.V347787.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s personal and healthcare needs are met, helping them to stay well. Service users’ health and wellbeing is promoted by generally good arrangements for the handling of medication, although the policy framework should be updated. EVIDENCE: As described, care plans included reference to how people’s personal care needs were to be met and to how they preferred to be supported. Issues around choice and privacy/dignity were noted. One care plan was seen to have been amended in response to comments from a service user about their preferences. During the visits people were seen being supported discreetly and to be offered a choice of who assisted them. Staff responded attentively to people’s requests for personal care support. Forest Green DS0000066989.V347787.R01.S.doc Version 5.2 Page 17 The people living in the home were seen to be dressed smartly and individually. Healthcare records for two people were checked. These provided evidence of people receiving routine and specialist healthcare services as required. Records of appointments and outcomes were seen to be clearly recorded in appropriate detail. Health action planning was not yet formally in place, though staff reported that templates were obtained and that this would be taken forward soon. Medication records appeared to be in order, although one person’s prescribed ‘as required’ medication had not been written up onto the current chart. This had been done by the time of the second visit. Some handwritten entries had just one signature. Ideally a second person should always check the entry and sign to indicate that they have done so. Medication storage also appeared to be satisfactory. The cupboard was in the kitchen. It was suggested that staff periodically check the temperature to ensure that it does not exceed 25°C. Staff were seen to clearly inform one person with a visual impairment that their medication was on the spoonful of food that they were about to consume. The Trust’s medication policy was seen to date from 2000, before the National Minimum Standards. This should be reviewed and updated to take into account the Standards as well as other relevant national guidance issued since then. Forest Green DS0000066989.V347787.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Arrangements are in place which help the people living in the home to express any concerns and dissatisfaction, helping them to feel listened to. Steps are taken which help to protect the people living in the home from harm and abuse. EVIDENCE: In the last report a requirement was made for the complaints procedure to include the name, address and telephone number of CSCI. A text and a more accessible version of the complaints procedure were seen to be available. However, contact details for CSCI had not yet been added. The manager said that this had been passed to the Trust for their attention. The manager stated that family members of the people living in the home had recently been sent a copy of the complaints procedure, along with a survey to complete it they wished to about the quality of care. According to the pre-inspection questionnaire there had been no formal complaints since the last inspection. Notes in communication care plans described how people made it clear if they were unhappy about something. Staff spoken with were able to demonstrate understanding of this and gave examples of how different people indicated Forest Green DS0000066989.V347787.R01.S.doc Version 5.2 Page 19 dissatisfaction. Daily records included examples of people raising issues that they were unhappy about and of these being addressed. Some of the people living in the home were asked if they felt able to say if they were unhappy. They indicated that they did and that staff were good listeners. The Trust has policies covering safeguarding adults and whistle blowing, although the latter dated from 2000 and should be reviewed. Training records provided evidence that staff had received recent training covering adult protection issues. Discussion with staff demonstrated a good understanding of issues and responsibilities in this area. People expressed confidence about being able to report concerns if they needed to. Staff had a clear understanding of the policy around covering the costs of staff refreshments when accompanying a service user for a drink or meal out. Records of service users’ finances were sampled. Receipts had been obtained for transactions where possible. These were clearly numbered and corresponded to entries. One person had purchased a nest of tables. Staff said that this would be added to the inventory at the next care team meeting. However, the person did not have an inventory on file. It is also recommended that significant purchases be added to inventories as soon as they are made. A significant number of entries on service users’ financial records had only one signature. Whilst is accepted that at times there is lone working, as far as possible all entries should be checked and signed by a second person. One person had received a loan from petty cash. Staff reported that whilst this practice was not generally condoned by the Trust it had been agreed on this occasion due to exceptional circumstances. Information about the PoVA scheme was seen to be available in the home. Staff described an issue between two service users and how they managed the difficulties which this presented. It was agreed that this issue would need careful assessment and management in order to safeguard service users’ wellbeing. Forest Green DS0000066989.V347787.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 & 30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. A clean, comfortable and homely environment is provided, although there is scope for further improving the quality of accommodation and some practices around food hygiene. EVIDENCE: At the time of the first visit a member of staff was doing some painting around the home. They described a number of other improvements they had made including putting up new shelving and stripping flaking paint from outside railings. They had also done some work to make the environment more homely, with further work planned. Since the previous inspection a number of other significant improvements had been made. This included decorating some bedrooms and other areas of the home, providing new furniture in bedrooms and communal areas and recarpeting the lounge and hallway. Staff understood that further redecoration Forest Green DS0000066989.V347787.R01.S.doc Version 5.2 Page 21 was due to take place, including painting the lounge and one person’s bedroom. This should be done since many areas of the home would still benefit from ‘freshening up’. Work had taken place throughout much of the basement area (including the laundry) to address damp. Staff understood that repainting of the affected areas was to follow, although the manager reported some resistance to this by the Housing Association. He was planning to continue to push for these areas to be redecorated despite not being a part of the home generally accessed by service users. One person had elected to move back into their former room. They confirmed that they had chosen the colour of the paint. Some of the people living in the home were asked about their bedrooms and the shared spaces. They indicated that they were happy with the environment provided at Forest Green. The first floor lounge had been completely redecorated and was now the office and sleeping-in room. The first floor bathroom had a small area of damaged plasterwork above the toilet cistern. This should be attended to. The door of this room was difficult to shut. This should also be addressed. At the time of the first visit the doorbell was not working. A letter from the Environmental Health Department in February 2007 was seen stating that the home was awarded a three star (good) rating based on an inspection in October 2005. Some dried skimmed milk was found in the kitchen with an expiry date of October 2006. This was disposed of during the visit. The fridge also contained a sandwich filling which needed to be used within three days of opening but which had been opened two weeks earlier. This indicates that greater vigilance is needed around dates of food items and disposal. During the first visit one person’s breakfast was made by a staff member whilst a colleague supported the person in the bath. The bowl of cereal was left uncovered on the table for 15 minutes before the person arrived to consume it. This should have been covered or kept in the fridge. The home was seen to be clean throughout. There were no offensive odours. Forest Green DS0000066989.V347787.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff are competent and skilled and have access to professional development opportunities, enhancing the quality of care. Training is provided which helps to equip staff with necessary knowledge although there is potential for some improvement. Updating the recruitment and selection policy would make the framework for employing new staff clearer and more robust. EVIDENCE: Discussion with staff along with training records provided evidence that the majority of the team had attained NVQ qualifications in health and social care. Staff spoken with indicated that they were being encouraged to progress further, for example, by taking the next level of NVQ. Observation along with discussion with staff indicated that team members had a good knowledge of the needs and conditions of the people living in the home. Forest Green DS0000066989.V347787.R01.S.doc Version 5.2 Page 23 Some of the people living in the home were asked about the support that they received. They were positive about the staff and indicated that they were happy with their care. As noted, some staff raised issues around inconsistent practice. The manager said that no new permanent staff had been taken on since the last inspection. He describe the steps that he would take when recruiting a new staff member and demonstrated awareness of the requirements of the Care Homes Regulations in this area. The Trust’s recruitment and selection policy was dated April 2004. This predates PoVA and associated changes to the Care Homes Regulations (although other more up to date policies and procedures did refer to staff being checked against the PoVA list). It should therefore be reviewed and updated. Staff expressed general satisfaction with the training that they received from the Trust, though said that there had been some initial difficulties with coordination and planning. Training records were looked at. These indicated that staff had access to a range of appropriate training courses. The following observations were made: • Whilst staff were generally receiving mandatory training at regular intervals some people were not recorded as having received training about moving & handling. One person was not recorded as having received fire safety training, though the manager said that this had been booked for the near future. Some staff felt that there should be more specialised training relating to service users’ needs and conditions to further develop team members’ understanding. Examples cited included training about autism, makaton and sensory impairment. Some people also felt that Positive Response Training (PRT) was required. • The manager was due to receive training about the Mental Capacity Act in August 2007. He reported that all staff would receive input about this legislation in due course. Some information about service users’ conditions was seen to be available in the home. Forest Green DS0000066989.V347787.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Outcomes for service users may be further enhanced by a more dynamic and creative approach, and through clearer direction and leadership. Systems are in place for checking and improving the quality of the service. Aspects of practice need to improve in order to help safeguard the health and safety of the people living and working in the home. EVIDENCE: The manager is a registered nurse. He obtained the Registered Manager’s Award in 2005. Forest Green DS0000066989.V347787.R01.S.doc Version 5.2 Page 25 Many staff felt that the service was generally running well. However, some felt that there was scope for improvement. Some staff felt that there was some resistance to change and a lack of creativity in practice, saying that this could be disempowering and demotivating both for staff and service users. There was a feeling that a senior seconded to the home recently had helped to bring about changes, although this person had now returned to their substantive post. Some people also felt that there needed to be more of a management presence and that the home required more assertive direction and leadership. Whilst the manager was reported to be approachable, some staff commented on how a new role overseeing another service was resulting in the manager being frequently off site. Some people felt that the team was left to its own devices, resulting in some lack of clarity, direction and dynamism as well as promoting inconsistent or controlling practice, albeit well intentioned. Some people also felt that the care team arrangement, with three or four staff involved in decision-making and reviewing around service users’ care, could make it difficult and slow to introduce changes. The above was put to the manager. He said that he was line managing an acting manager in another service, but that this commitment would now be reduced to an average of one day per week. He also described plans for a full time senior staff member to be in place in the near future. These developments should help to address the concerns expressed by some staff as outlined above. The manager felt that the team had been strengthened by a recent teambuilding day. He acknowledged that changes in practice posed a challenge to the team, but said that this was being addressed at staff meetings, care team meetings and, on an individual basis, in supervision sessions. The manager acknowledged the issues noted about the care team approach, but also pointed out the benefits of having more people involved in discussion and decision-making. In the last report it was noted that the manager had begun a programme of professional development courses related to his role, including areas such as the process of management, budgeting, performance management, leadership and coaching. He said that the majority of this had not happened for various reasons, although he had been on courses about person-centred planning and diversity. He was planning to take further management-related courses when he had the opportunity. Staff described the manager as very fair, empathic and understanding. Forest Green DS0000066989.V347787.R01.S.doc Version 5.2 Page 26 Minutes from a recent residents’ meeting were seen. Some of the people living in the home contribute to these meetings, though others have more difficulty. Staff confirmed that individual feedback about their care is obtained from service users on a day-to-day basis and as part of care team reviews. People living in the home gave examples of when their views were sought, for example about the colour of their room. Regulation 26 reports are being forwarded regularly to CSCI. These reports are made following an unannounced visit by a representative of the service provider and take place about once a month. One of the people living at Forest Green was a member of a Brandon Trust service users’ group. They attended regular meetings and were asked to feedback about services and plans. The manager said that some surveys had been devised by the team and forwarded to family members. A copy of the form was seen. To date there had been one reply, resulting in dialogue with the person and steps taken to address any issues raised. The Trust has a series of core quality standards. These are subject to review and periodic audits take place against them in the Trust’s services. An action plan had been drawn up for the home following the recent audit. The manager could not locate a copy but agreed to forward this when found. The main findings were reported to relate to introducing a more person-centred form of care planning and to improving supervision arrangements for staff. Staff spoken with did not express any specific health and safety concerns and felt satisfied that this area was well managed. Documentary evidence of various routine checks was seen. These included fridge and freezer temperatures, gas appliance servicing and portable appliance testing (PAT). Pat testing had last taken place in June 2006 according to records and should therefore be repeated. The fire risk assessment was not checked, although some individual protocols about service users’ in respect of fire safety were seen. There was documentary evidence of servicing of fire equipment in May 2007. However, the fire log indicated that there had been no testing of emergency lights or fire alarms in July 2007 (the last fire alarm test was recorded as being June 25th 2007). This slippage should be urgently addressed. It had been noted in the previous inspection report as well as a Regulation 26 report from April 2007. In the last report it was suggested that the team consider whether window restrictors should be fitted on the first (and possibly parts of the ground) floor. The manager said that this issue had not been formally risk assessed recently. It was agreed that this should be done, along with assessments of any other Forest Green DS0000066989.V347787.R01.S.doc Version 5.2 Page 27 potentially significant environmental hazards, such as access to the steep flight of steps leading to the basement. This may result in it being decided that no action is necessary, but it was agreed that it was important to document the assessment and decision-making process. Forest Green DS0000066989.V347787.R01.S.doc Version 5.2 Page 28 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 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 2 STAFFING Standard No Score 31 x 32 3 33 x 34 2 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 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 x 2 x Forest Green DS0000066989.V347787.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? YES 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 YA22 Regulation 22 (7) Requirement The complaints procedure must include the name, address and telephone number of CSCI. Timescale of 28/02/07 not met. Timescale for action 31/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA2 YA6 Good Practice Recommendations The Trust should fully review and update the admissions policy dating from 2000. Ensure that reviews of care plans are consistently documented and that changes to care plans have the date and author noted. When care plans are becoming hard to read due to the number of handwritten additions these should be retyped. Where limitations and restrictions exist the rationale should be made as clear as possible and be subject to regular review as part of routine review of all care plans. Forest Green DS0000066989.V347787.R01.S.doc Version 5.2 Page 30 3 4 5 6 YA12 YA17 YA19 YA20 Begin to adopt the approaches to capacity and best interests described in the Mental Capacity Act and accompanying code of practice and reflect this in documentation. Continue to develop the activities programme for the person who has most recently moved into the home. Where it is assessed that specific issues need to be monitored such as consumption of fruit and vegetables ensure that this is consistently done. Fully implement health action planning as soon as possible. Ensure that all ‘as required’ medication is written up on the MAR chart. Periodically check the temperature of the medication cabinet to ensure that it does not exceed 25°C. When it is necessary to make a handwritten entry on the medication administration record, a second person should check this entry and sign the record. The Trust’s medication policy dated 2000 should be reviewed as soon as possible to take into account the National Minimum Standards as well as other relevant guidance since then. Review the whistle blowing procedure dating from 2000. Continue to assess and manage issues around conflict between service users, ensuring that people’s dignity and wellbeing is safeguarded. Draw up an inventory for the person who had most recently moved into the home. Significant purchases should be added to inventories as soon as possible after they are made, rather than waiting for a care team meeting. As far as possible all entries in service users’ finances records should be checked and signed by a second person. 7 YA23 8 YA23 9 YA24 Continue work on ‘freshening up’ areas of the home with tired or worn paintwork, including in the basement. Attend to the small area of damaged plasterwork above the toilet cistern in the first floor bathroom. In the same room, undertake necessary work to ensure that door can be easily closed. Forest Green DS0000066989.V347787.R01.S.doc Version 5.2 Page 31 10 YA30 Ensure that the doorbell works. Consider the systems in place around date checking and disposal of food see notes in text). Address issues around food hygiene/covering of food noted in text. Review and update the policy on recruitment and selection to take into account changes to legislation and practice. Make arrangements to provide staff with appropriate training about moving and handling. Check that all staff have received appropriate training about fire safety. Continue to provide specialist training for staff related to service users’ needs and conditions, as outlined in the text and previous reports. Consider issues raised through the inspection process about management and culture in the home including: • • • • • • Management presence Direction and leadership Changing and updating practices Promoting creativity and initiative Care teams Empowerment of service users and staff 11 12 YA34 YA35 13 YA37 14 YA42 The manager should undertake relevant professional development courses related to management such as those cited in the text which had been previously planned. Check if PAT testing is due again. Ensure that fire alarm tests happen every week and that emergency lighting is tested on a monthly basis. Review or undertake risk assessments relating to potentially significant environmental hazards, including in relation to window restrictors and access to the basement. Forest Green DS0000066989.V347787.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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 Green DS0000066989.V347787.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!