Inspection on 10/05/05 for Forest House

This inspection was carried out on 10th May 2005.

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 but made no statutory requirements on the home.

Other inspections for this house

Forest House 15/04/09

Forest House 11/04/07

Forest House 08/05/06

Forest House 25/10/05

Forest House 11/11/04

Forest House 15/06/04

Forest House 10/02/04

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

CARE HOME ADULTS 18-65 Forest House Church Square Newnham Road Blakeney Gloucestershire GL15 4AA Lead Inspector Richard Leech Unannounced 10 May 2005 09:00 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 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 Stationary 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 House D51_D03_S16440_ForestHse_V226522_100505_Stage4_U.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Forest House Address Church Square Newnham Road Blakeney Gloucestershire GL15 4AA 01594 516825 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Park Care Homes (No2) Ltd To be appointed Care Home 8 Category(ies) of LD - Learning disability both(8) registration, with number of places Forest House D51_D03_S16440_ForestHse_V226522_100505_Stage4_U.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: N/A Date of last inspection 11TH November 2004 Brief Description of the Service: Forest House is registered to provide care for up to eight adults with a learning disability. The Statement of Purpose indicates that service users may also have a stable associated mental health disorder, although their primary needs would relate to learning disability. The home is operated by Parkcare Homes, which is a subsidiary of the Craegmoor Healthcare group. The home is in the small village of Blakeney in the Forest of Dean. The building is a renovated and refurbished stone cottage. Whilst this gives the home character, it also means that there are low ceilings and doorways, fairly steep staircases and steps to many of the rooms on the ground floor.The home provides 24-hour staffing. All residents have single rooms, some of which have en-suite facilities. The residents have access to a communal lounge and dining room. Outside there is a patio and stepped access to the garden. Forest House D51_D03_S16440_ForestHse_V226522_100505_Stage4_U.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection began at 09.00 and lasted until about 17.30. The acting manager was available throughout the inspection. There were two inspectors present. A variety of records were looked at including care plans, risk assessments, staff files and healthcare notes. Most areas of the building were looked at, although not every bedroom was checked on this occasion. Four staff were spoken with. Over the course of the day the inspectors met all eight of the service users. Comment cards were left for people to complete and send on in case there was anything else that they wanted to say. Some feedback was provided by an agency involved in service users’ care. The inspection focussed on case tracking three service users. Their records and care were looked at in more detail. Four requirements from the last report were found not to have been met within the timescales agreed. What the service does well: What has improved since the last inspection? Care plans and risk assessments have improved since the last inspection, though there is still some way to go with making them clearer and more individual. Good use has been made of advocates to help service users decide how they want to spend their time. Some people have chosen to try work experience rather than go to the day centre. Service users are being listened to more and supported to take greater control over their lives. Activities are more individual and varied. Some of the service users talked about their activities and jobs and Forest House D51_D03_S16440_ForestHse_V226522_100505_Stage4_U.doc Version 1.30 Page 6 indicated that they enjoyed them. One person was looking forward to starting a new work experience placement that day. The systems and training for medication have improved. Staff are more confident and skilled in this area. The building has improved a great deal in the past couple of years, and is now much fresher, brighter and more attractive. More improvements are planned. Food hygiene in the home is better, although one or two areas still need attention. The way that the home checks the quality of the care it provides has improved, though this needs thinking about more so that all of the service users’ have the chance to give their thoughts and opinions. What they could do better: Some confidential information had been left out/unlocked. All personal information needs to be stored securely. Service users are getting the healthcare that they need, though records of this are not clear and could be better. The kitchen was very hot at the time of the inspection, making it very unpleasant to be in the room. There are major problems with the laundry room. It is too hazardous for residents to use it on their own. This means that staff have to be with them, making the service users feel less independent. There is also no sink, only one (unreliable) washing machine and poor ventilation. The shared bathroom on the first floor is becoming quite difficult for some people to use and should be adapted so that it is safe and comfortable for everyone. Now that there are eight people living in the home the lounge is slightly small. There should be more shared space. Staff do not have full awareness and understanding of service users’ mental health conditions and of how to support them with this. There was a lack of knowledge of people’s care plans around mental health. Also, whilst the management of challenging behaviour has improved there is still some inconsistent practice. There need to be more staff so that there are enough people to support service users with the different activities they want to take part in. The manager had realised this, and new staff were being recruited at the time of the inspection. Care needs to be taken to make sure that recruitment is done properly. Some staffing files did not have all of the information that is needed. Forest House D51_D03_S16440_ForestHse_V226522_100505_Stage4_U.doc Version 1.30 Page 7 There have been a number of temporary managers. The home needs to have stable management and an application must be submitted for a manager to register with CSCI. The manager is not getting the full support that she needs from her managers and other people in the organisation. Not all of the recommendations from the last report were looked at this time. Although the home does not have to follow these, the manager should look at them and make sure that those that are still relevant and will improve the quality of care have been done. 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. Forest House D51_D03_S16440_ForestHse_V226522_100505_Stage4_U.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Forest House D51_D03_S16440_ForestHse_V226522_100505_Stage4_U.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: None of the outcomes in this section were fully considered on this occasion. The acting manager has reviewed and updated the Statement of Purpose and Service Users Guide. This includes deleting a reference to a transport charge which is not currently being applied. These documents will be reviewed in more detail in future inspections. Forest House D51_D03_S16440_ForestHse_V226522_100505_Stage4_U.doc Version 1.30 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 9 & 10 Whilst there has been an improvement in care plans and risk assessments many remain contradictory and unclear, which could affect the consistency of care and ultimately place service users at risk. Service users are being empowered more and supported to make and follow through meaningful choices in their day-to-day lives. Personal information is not being handled appropriately, jeopardising service users’ confidentiality. EVIDENCE: Files included a range of care plans covering appropriate areas. However, in many cases they had not been reviewed for several months (in some instances since July 2004). Some are in need of urgent review. For example, one care plan described a staged assessment of road safety skills but gave no indication of what progress had been made/stage reached. Staff gave different answers when asked if the person went out on their own or accompanied when in the village. In another case a care plan had been written following a road safety incident but other linked care plans (and risk assessments) needed review to ensure relevance and compatibility. A behaviour therapist continues to work with the team to generate thorough care plans and protocols around managing challenging behaviour. Care plans about mental health care have improved Forest House D51_D03_S16440_ForestHse_V226522_100505_Stage4_U.doc Version 1.30 Page 11 since the last inspection but some staff did not demonstrate awareness of these plans or a reasonable understanding of the mental health issues. Workers from an agency involved with the home expressed concerns about staff sometimes appearing to create (inappropriate) care plans through word of mouth which bear little relationship to written plans and protocols. Concern was also expressed about staff skills around managing challenging behaviour and mental health issues. Some person-centred work involving the service users has been done, though this needs development. Further training and ongoing support around care planning (particularly person-centred work) should be offered to staff to consolidate training from 2004. There should be a review of the different sets of notes and records in use, since there may be unnecessary repetition (such as around how a person slept or the food that they ate). Most care plans and assessments were dated and signed, but some were missing this information. Many care plans placed an emphasis on service users taking more control over areas of their lives such as finances. This is a positive development. Service users described some of these changes to the inspectors. There was also evidence that people are being empowered to take make decisions about how they spend their time (see ‘lifestyle’ section). This and other areas of choice have involved the use of advocates. Good use has been made of this resource. Staff and service users confirmed that people go to bed and get up when they choose (though are encouraged to get up in time for commitments). The manager said that the team is trying to encourage people to avoid changing into nightclothes very early in the evening, though this pattern is difficult to break. The manager said that provision of more evening activities has helped. Service users’ finances were not looked at in detail on this occasion. One person said they had very little money. The manager confirmed this. It was agreed that a benefits check would be useful to ensure that they are claiming all their entitlements. Social services may be able to assist. Service users could also be asked if they would like more support and care planning on budgeting. Some risk assessments have standard headings and are not personalised besides the service user’s name being added. Some contradicted care plans, such as about whether a person has a key or not. Many risk assessments required urgent review, such as one on road safety (last reviewed on 19/10/04 but noted on file as needing weekly review). Others did not reflect the many skills and strengths that people had. The manager referred to past training about risk assessments though said that this had not been particularly helpful. She said that work on risk assessments had come to a standstill. As with care planning, additional support and training in this area appears necessary. Some personal information was written in handover and communication books left out near the lounge. A cabinet containing confidential information was unlocked. Confidential information must be securely stored. Forest House D51_D03_S16440_ForestHse_V226522_100505_Stage4_U.doc Version 1.30 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 15, 16 & 17 Activity provision has improved and people are supported to access a wider range of pursuits according to their needs and interests, and to take advantage of opportunities in the local community. Within the home, routines are more flexible and service users are involved in the running of Forest House. Staff support service users to maintain contact with family and friends. A varied, healthy diet is offered. Support is provided to help service users to take more control over this area of their lives. EVIDENCE: Three service users’ care notes were used to track their activities. These included meetings with advocates, trips to local towns and cities, walks in the village, leisure pursuits in the home, aromatherapy, day centre, having meetings about ideas for vocational activities, and going out for drives. Provision varied a great deal for each person. This is expected, though it was noted that some people appeared to spend considerable periods in the home doing low-key activities such as watching TV and domestic tasks. However, the Forest House D51_D03_S16440_ForestHse_V226522_100505_Stage4_U.doc Version 1.30 Page 13 notes also demonstrated that staff are supporting people to have more flexible routines and to follow their interests. For example, one person has joined a library as they are interested in books, and may also be supported to try some work in a charity shop. One service user has been supported to go ice-skating and there are plans to go again, and they are also attending a local club in the community which they wanted to try. There was evidence that service users are being supported to get jobs and to explore work-based ideas. Use has been made of advocacy services to help people decide if they want to go to day centres or would prefer to spend their time in different ways. Service users spoken with were generally positive about how they spent their time, describing involvement in household tasks such as shopping and cleaning, leisure pursuits and a move away from day centres. Some staff suggested that a shortage of drivers was having a negative impact on activity provision. One person’s day-care folder (provided by the centre) was very confusing and inaccessible. The inspectors suggested that the manager discuss this with the centre to make it easier to follow and more meaningful. Records showed that service users are supported to maintain contact with family and friends. One person had a care plan about a personal relationship, as required in the last report. However, it had not been reviewed and updated to take into account a change of circumstances. This relates to the requirement made in the previous section about reviewing care plans at appropriate intervals. There was evidence that appropriate action was being taken (including multi-disciplinary liaison) where issues were identified between people living in the home. This is an area that will be closely monitored during future visits since they impact profoundly on service users’ wellbeing. Notes and discussion with service users provided evidence that they are involved in daily routines and household tasks and that they enjoy this. Supervision is still required for service users to access the laundry, due to this environment presenting hazards and being generally unsuitable. This is documented in care planning files, but is a regrettable limitation on freedom and a barrier to independence. See section on environment. Menus provided evidence that service users are offered a varied diet including fresh fruit and vegetables. There was evidence that more fresh fruit had been provided for breakfast following requests from some service users. Staff spoken with confirmed their knowledge of fluid monitoring for some people, and of the reason for this. One person has chosen to lose some weight, but the support that staff were to give was not yet documented in a care plan. Forest House D51_D03_S16440_ForestHse_V226522_100505_Stage4_U.doc Version 1.30 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 & 20 Personal support is provided in a flexible and individual way and service users are enabled to express their personalities. Service users’ healthcare needs are assessed and met, though inconsistent documentation in this area could put service users at risk. Systems for the handing of medication are more robust and staff are better trained and have greater confidence in this area than before. EVIDENCE: Service users were dressed individually and had personal accessories and hairstyles of their choice. Daily notes described staff supporting people to have their nails painted and to access services such as aromatherapy. Staff spoken with described how they supported service users with their personal care needs in a way which respected their dignity and wishes. Healthcare records provided evidence that service users were being supported to access routine healthcare regularly. However, the information was held in different sets of notes in various parts of the home and they did not all correspond. This is potentially confusing and may be a source of unnecessary Forest House D51_D03_S16440_ForestHse_V226522_100505_Stage4_U.doc Version 1.30 Page 15 repetition. One person had an incomplete heath action plan which, if finished and updated, could be an excellent resource and reference tool. Records and discussion provided evidence that the Community Learning Disability Team are involved with many of the service users in the home, providing direct interventions and also support for the team. One person had just been referred for speech and language therapy. A professional who visits the home said that they could always see service users in private. Staff spoken with expressed uncertainty about service users’ mental health conditions and how to offer appropriate support. In some cases there were significant misconceptions and lack of awareness. This has been a longstanding source of concern to the Commission. Although there are care plans about aspects of mental health, and accompanying background information, staff did not consistently demonstrate appropriate understanding of this area. Concern was also expressed from an external source that the manager and staff did not always know the appropriate sources of support to call upon in the event of a service user experiencing an acute deterioration in their mental health. Protocols and procedures for this should be reviewed and clarified. Following the pharmacist inspector’s visit in 2004 changes have been made to the home’s medication systems to make them clearer and safer. Some new local procedures have been drawn up to complement the general policy on handing of medications (some feedback on this was provided to the manager). Files include user-friendly, signed forms for consent to medication. There are assessments about people’s capacity to self-administer. Staff have undertaken training in handling medication through a pharmacy and a local college to supplement in-house training. One service user described a medication error that took place in October 2004. The measures in place should reduce the risk of further errors. This is an area which the Commission will monitor closely. Medication administration records and storage appeared to be in order. A list of staff signing for medication needed updating with some additional signatures. Some work has been done with service users and their families about wishes in respect of illness, dying and death. This work continues, and the manager has conducted some in-house awareness training with staff. Forest House D51_D03_S16440_ForestHse_V226522_100505_Stage4_U.doc Version 1.30 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 & 23 There is support for service users to air their views and concerns, and staff are acting on these. Procedures and systems are in place to help protect service users from being placed at risk of harm and abuse. EVIDENCE: Minutes from a residents’ meeting in January showed that the complaints procedure had been discussed. The acting manager has updated it with her name. As noted, the team has made very good use of advocacy services to empower people to air any concerns about their activity programme and to express their views about how they want to spend their time. Advocates have also been involved in cases where concerns about other aspects of life at Forest House have caused service users concern. Risk assessments and protocols for managing challenging behaviour have been drawn up. A behaviour therapist has been involved in this work. Staff spoken with demonstrated awareness of these and of how they translated into practice. Nonetheless, the inspectors have concerns about some recent incidents in the home, and in particular incidents of violence and harm. This is another area which will be closely monitored. As of January 2005 the action plan for the home indicated that 10 staff had received CPI training (a system for managing challenging behaviour accredited by BILD). The manager has delivered an awareness-raising session about protection of vulnerable adults. The signatory on one service user’s bank account has been changed, meaning that the service user can now access the money in this account. Forest House D51_D03_S16440_ForestHse_V226522_100505_Stage4_U.doc Version 1.30 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 26, 27, 28 & 30 The environment in the home has shown continuous improvement in recent years and provides a generally pleasant, homely and comfortable place to live, both in terms of shared areas and people’s bedrooms. However, there is a lack of communal space. Provision of bathrooms and toilets is uneven, and not all service users have access to facilities that meet their needs. A clean, hygienic and safe environment is generally maintained, although some shortfalls in particular areas compromise this. EVIDENCE: Since the last inspection the first floor toilet has been repainted. At the time of the visit the hall and stairs were being redecorated and a new doorway had been created from the hall to the dining room. Over the past couple of years there has been evidence of a systematic programme of improvement and redecoration in the home, making it more pleasant and homely. Inspection of the premises and discussion with the manager provided evidence that work required in the last report has been undertaken. Forest House D51_D03_S16440_ForestHse_V226522_100505_Stage4_U.doc Version 1.30 Page 18 The kitchen and dining room were very hot at the time of the inspection (in particular the kitchen). Steps should be taken to make the atmosphere more pleasant when the heating is on, such as turning the radiators down. Some service users showed the inspectors their rooms and indicated that they were happy with them. They were personalised and pleasantly decorated. There are toilets on the ground and first floors, and a communal bathroom on the first floor. Four rooms have en-suite showers and four have en-suite toilets. It was agreed that ideally the home would have another communal bathroom. However, the existing one needs attention since it does not fully meet residents’ needs in terms of accessibility. This will require involvement from professionals such as Occupational Therapists and provision of any necessary aids and adaptations. The manager said that there had been plans to do this work, but that this now seemed to be on hold. The cellar remains unused. It was agreed that it is a potentially useful addition to communal space, particularly given that the home is currently full and the lounge is relatively small. The laundry is not entirely fit for purpose. It has poor ventilation, no sink and cannot be accessed by service users independently due to particular hazards such as a slippery floor. The manager also said that the machine regularly breaks down and that there should be a separate one for some items for infection control reasons. Although there were paper towels in stock the toilets and bathrooms had run out. In the kitchen some bread dated May 8th was found. A container of cereal had no label to indicate when they were opened. There should be regular, thorough checks of dates and labelling. Forest House D51_D03_S16440_ForestHse_V226522_100505_Stage4_U.doc Version 1.30 Page 19 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 34, 35 & 36 Staffing numbers need to increase to ease pressure on existing staff and to offer more individualised, opportunity-rich support for service users. Some shortcomings in the recruitment process could put service users at risk from unsuitable carers being employed. Service users are supported by a better-trained staff team than in the past, though there remain significant shortcomings in the quality and delivery of training, and in staff skills and knowledge, which could compromise service users’ care and put staff in a vulnerable position. Staff are now offered more support and supervision but there is scope for further improvement which should in turn improve the quality of care. EVIDENCE: Some requirements relating to clarifying staff roles and responsibilities made in the last report have been actioned, although it was agreed that copies of updated job descriptions should be kept in staff files. However, a requirement about providing guidance for staff on maintaining professional boundaries with one service user has not yet been implemented. The manager said that there had been liaison with the Community Learning Disability Team about this. The manager said that three new staff were being recruited, with the possibility of more staff being needed if other service users chose not to continue attending day centres. In the meantime agency staff were being used Forest House D51_D03_S16440_ForestHse_V226522_100505_Stage4_U.doc Version 1.30 Page 20 to cover gaps in the rota. On occasions staff are working 14-hour shifts. This could compromise service users’ care due to staff becoming tired. Carers spoken with agreed that the home was short staffed at the time. The manager conceded that there should generally be a minimum of three staff on daytime shifts but that this was often not the case (although the recruitment exercise will make this more feasible). It was agreed that, as (acting) manager her hours should be supernumerary. In the last report a requirement was made for new staff to also be supernumerary until they have the necessary qualities, competencies and experience to meet service users’ needs. This had not been the case for a person who had recently joined the team. Staffing files included required documents. However, an application form from 2005 did not provide a full employment history. From/to dates for periods of employment were given just in years. The history also only went back a decade rather than being full. In addition, the person had worked in social care in the past but the home had accepted two references from other work areas, contrary to the Care Homes Regulations. The form asks for the most recent employer and should be updated to reflect the change in the Regulations. The manager said that all staff had completed LDAF accredited induction and foundation and were awaiting the outcome having sent their work for checking. Selected training records provided evidence that staff were up to date with core training. Some training has recently taken place in manual handling, protection of vulnerable adults, infection control and challenging behaviour. Some training was due on 12/05 in bereavement. Some mental health training has been arranged for June 16th by MIND. The latter is long overdue and it was agreed that this is just the start of the ongoing training process for supporting staff to work with service users who have mental health issues. There may be a need for staff to have further training about managing challenging behaviour. External feedback indicated that this is not always handled consistently and appropriately, and that staff may be reactive, rather than having the skills to identify and manage changes in mood and behaviour at an early stage, and to recognise triggers and antecedents to unsettled behaviour. Training in food hygiene, infection control and adult protection had been done in-house by the acting manager. The inspectors expressed concerns about this in terms of the manager not having the qualifications and training to train others in these areas. These are potentially useful supplements to training from experienced and qualified trainers but the inspectors would be concerned if this in-house training replaced the usual external courses and strongly recommend that this should not be the case. In the meantime the suitability of the in-house food hygiene training will need to be checked with the local environmental health team to check if it meets standards required by law. Records showed that most staff had recently had a supervision meeting with the manager. She plans to offer regular supervision meetings and is hoping to reintroduce staff appraisals in the near future. Following the inspection she said that she had received some training in supervision and appraisal. The quality of these areas in the home will be monitored in future inspections. Forest House D51_D03_S16440_ForestHse_V226522_100505_Stage4_U.doc Version 1.30 Page 21 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 39 & 42 A succession of temporary management arrangements has jeopardised the quality and consistency of care. Systems are in place for the home to monitor the quality of care provided. This includes seeking feedback from service users, though there is scope for further improvement in this area. Some significant shortfalls in areas of health and safety could put service users at risk. EVIDENCE: The Commission will expect an application for a manager’s registration in the near future. The ongoing absence of a registered manager is extremely concerning. In the meantime, the acting manager should receive intensive support and supervision from senior workers in the organisation to ensure that the home is well run and that progress and improvement continue. The acting manager expressed some concerns that she was not receiving as much support as she needed. Forest House D51_D03_S16440_ForestHse_V226522_100505_Stage4_U.doc Version 1.30 Page 22 There are monthly residents’ meetings. A residents’ questionnaire had been completed collectively as part of service users’ feedback. It was not clear how this had been obtained. The manager said that this would now be done individually and that they would aim for a more accessible version to be produced. The manager is also undertaking a satisfaction survey of family members and had received two responses at the time of the inspection. The Commission is receiving copies of reports from monthly unannounced visits by a representative of the provider. Some professionals who visit the home confirmed that they were always asked to provide identification and to sign in. Inventories for service users have been produced. These are signed and dated. However, one person’s recent purchase of an adapted bed had not been added. These must be updated when a service user purchases furniture. The Commission also requires a written explanation to be forwarded of the reasons for the service user paying for their own adapted bed required to meet their assessed needs, and of the decision-making process for purchase of this item. Records of hot water temperatures showed a great range. On the April records they varied from 20 degrees centigrade (in one bedroom) to 50 degrees (in the first floor toilet). At the time of the inspection the first floor toilet was producing cold water from both taps. These temperatures are unacceptable and work must be undertaken to ensure that hot water temperatures are at an appropriate level. A new automatic closing device has been fitted to the lounge door. Fridge and freezer temperature records were acceptable. The fire log was not checked on this occasion. Forest House D51_D03_S16440_ForestHse_V226522_100505_Stage4_U.doc Version 1.30 Page 23 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 x 2 2 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x 3 2 2 x 2 Standard No 11 12 13 14 15 16 17 x 3 3 x 3 2 3 Standard No 31 32 33 34 35 36 Score x x 1 1 2 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Forest House Score 3 2 3 x Standard No 37 38 39 40 41 42 43 Score 1 x 3 x x 2 x D51_D03_S16440_ForestHse_V226522_100505_Stage4_U.doc Version 1.30 Page 24 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 6 Regulation 12 (1) a & b. 13 (4). 15 (1) & (2). Requirement Review and update care plans at appropriate intervals, ensuring that they remain as up to date as possible and that staff are following them in a consistent way. Involve other professionals/agencies in the review and generation of care plans as necessary. Ensure that staff are fully aware of care plans and of any accompanying information and guidance (such as around mental health issues). Review and update all risk assessments at suitable intervals. Confidential information must be securely stored (Timescale of 11/11/04 not met). Undertake necessary work such that the laundry is fit for purpose and can be safely accessed by service users independently where appropriate. Provide guidance for staff on maintaining clear professional boundaries with one person, as discussed in previous reports, to ensure that their actions do not Timescale for action 31/07/05 2. 3. 4. 9 10 30 12 (1) a & b. 13 (4). 14. 17 (1) b 13 (4). 16 (2) f. 23 (2) a & k. 12 (4) & (5) 31/07/05 15/06/05 31/10/05 5. 32 31/07/05 Forest House D51_D03_S16440_ForestHse_V226522_100505_Stage4_U.doc Version 1.30 Page 25 6. 33 12 (1) a & b. 18 (1) a & (2) 7. 34 19. Sch. 2 (3) & (6). compromise their dignity and that their emotions are understood and responded to appropriately. Consult with others involved in their care as necessary (Timescale of 31/08/04 not met). New staff must be supernumerary until they have the necessary qualities, competencies and experience to meet service users’ needs (timescale of 15/12/04 not met). Applicants must provide a full employment history, together with a satisfactory written explanation of any gaps in employment. Where applicable, a reference from a prospective employees most recent social care employer must be obtained where this employment was of three months duration or more. 15/06/05 15/06/05 8. 35 Apply the above retrospectively where these have not been followed for staff starting since July 2004. 12 (1) a & Consult with Environmental b. 13 (3). Health as to whether the in!8 (1) c (i) house food hygiene training meets their criteria for adequate supervision, instruction and/or training in food hygiene. Ensure that all staff have the necessary training and skills to work appropriately with service users who may express challenging behaviour and/or have mental health difficulties. The registered provider must ensure that an application for registration of a manager is submitted (Timescale of 31/08/04 not met). 31/07/05 9. 37 8 31/07/05 Forest House D51_D03_S16440_ForestHse_V226522_100505_Stage4_U.doc Version 1.30 Page 26 10. 41 17 (2). Sch.4 (10). 16 (2) c. Ensure that items of furniture purchased by service users are added to their inventories. Forward a full explanation to the Commission of the reason for a service user purchasing their own adapted bed rather than this being provided in line with their assessed needs. Work must be undertaken to ensure that hot water temperatures are at an appropriate level for each outlet. Fit any aids and adaptations required to safely meet service users’ needs in the first floor bathroom and to make the facilities fully accessible. (This should involve appropriate liaison with professionals such as Occupational Therapists). 15/06/05 11. 42 12 (1) a. 13 (4). 23 (2) a & n. 31/10/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 6 Good Practice Recommendations Review the different sets of books, notes and records in use, considering whether there is unnecessary repetition. Further training and ongoing support around care planning (particularly person-centred work) should be offered to the manager and staff. Ensure that all care plans and assessments are dated and signed. Ensure that service users are claiming all benefits to which they are entitled. Where appropriate ask if people would like further support and care planning around budgeting. Continue to develop an emphasis in care planning and practice on promoting service users independence and Forest House D51_D03_S16440_ForestHse_V226522_100505_Stage4_U.doc Version 1.30 Page 27 2. 7 3. 4. 9 12 supporting them to take more control over their lives. Further training and ongoing support around risk assessment (ideally with a person-centred focus) should be offered to the manager and staff. Continue to use person-centred care planning and risk assessment to support people to further develop activity plans based on their individual needs and interests. Address the issue of the shortage of drivers. Document through care planning the teams role in one service users decision to lose weight, including any agreed support and encouragement around areas such as diet, exercise, weight monitoring, transportation and liasion with health professionals. Organise healthcare notes such that they are all in one place, thereby providing clear, consistent information about appointments, outcomes and necessary actions. Review and clarify procedures for seeking support from other professionals/agencies in the event of an acute deterioration in a service users mental health. Ensure that all staff involved in the administration of medication have signed the list of staff who have this responsibility. Take steps to prevent the kitchen and dining room from becoming unpleasantly hot when the heating is on. The first floor bathroom should be refurbished. Consider refurbishing the cellar and using this as an additional lounge and/or activity room. Consider whether additional washing machines are necessary in terms of infection control. Consult with Environmental Health as necessary. Ensure that paper towel dispensers in toilets and bathrooms are regularly restocked. There should be regular, thorough checks of best-before dates and of food labelling in the kitchen. Copies of updated job descriptions should be kept in staff files. Avoid staff doing excessively long shifts to covers gaps in the rota. Use agency staff to cover any shortfalls if necessary. Aim to have a minimum of three staff on daytime shifts when needed. Ensure that the managers hours are supernumerary. Review the application form to make it clear that under D51_D03_S16440_ForestHse_V226522_100505_Stage4_U.doc Version 1.30 Page 28 5. 17 6. 19 7. 8. 9. 10. 11. 20 24 27 28 30 12. 13. 31 33 14. 34 Forest House 15. 35 certain circumstances a reference from the persons last social care employer is needed even if this is not their most recent post. In-house training being delivered by the acting manager should supplement, rather than replace, training provided by qualified, experienced external trainers. Continue to support staff to be proactive in the management of challenging behaviour, and to be able to recognise and appropriately manage service users changes in mood, along with triggers and antecedents. Consider whether some staff would benefit from further basic training about learning disability on top of the LDAF induction and foundation, such as LDAF stand-alone units at level two or a full LDAF certificate. Continue to aim for all staff having regular supervision meetings and an annual appraisal. The acting manager should receive intensive support and supervision from senior workers in the organisation to ensure that the home is well run and that improvement continues. 16. 17. 36 37 Forest House D51_D03_S16440_ForestHse_V226522_100505_Stage4_U.doc Version 1.30 Page 29 Commission for Social Care Inspection 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester GL3 4AB National Enquiry Line: 0845 015 0120 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 House D51_D03_S16440_ForestHse_V226522_100505_Stage4_U.doc Version 1.30 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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