Inspection on 08/05/06 for Forest House

This inspection was carried out on 8th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Forest House 15/04/09

Forest House 11/04/07

Forest House 25/10/05

Forest House 10/05/05

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 Glos GL15 4AA Lead Inspector Mr Richard Leech Key Unannounced Inspection 8th May 2006 09:40 Forest House DS0000016440.V293837.R02.S.doc Version 5.1 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 House DS0000016440.V293837.R02.S.doc Version 5.1 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 House DS0000016440.V293837.R02.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Forest House Address Church Square Newnham Road Blakeney Glos GL15 4AA 01594 516825 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.craegmoor.co.uk Parkcare Homes (No. 2) Limited To be appointed Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Forest House DS0000016440.V293837.R02.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th October 2005 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 service users have single rooms, some with en-suite facilities. There is a communal lounge and dining room. Outside there is a patio, outbuildings and stepped access to the garden. Forest House DS0000016440.V293837.R02.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection began on a Monday morning, lasting until early evening. Most of the service users were met over the course of the day, along with several members of the staff team. The manager was present throughout the inspection. All of the communal areas of the home were checked as well as some service users’ rooms. A range of documents were looked at during the day including samples of care plans, medication records, risk assessments, maintenance files and daily notes. The manager distributed comment cards to people involved with service users’ care, some of which have been returned to CSCI. What the service does well: What has improved since the last inspection? The manager has applied for registration. Stable management for the home now appears to be in place after a long period of management change. Further improvements have been made throughout the home. These include creating a new, larger bathroom by knocking through to a toilet next door and Forest House DS0000016440.V293837.R02.S.doc Version 5.1 Page 6 fully refitting the laundry. A much more homely, pleasant and comfortable environment is being provided. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Forest House DS0000016440.V293837.R02.S.doc Version 5.1 Page 7 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 House DS0000016440.V293837.R02.S.doc Version 5.1 Page 8 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 the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Appropriate procedures are in place which help to ensure that the home admits people whose needs can be met there. EVIDENCE: Staff reported that one person had been to visit the home on the day before the inspection. The manager confirmed this, adding that they had come for tea, with a view to possibly moving in. He said that there would be a multidisciplinary meeting the following day to consider the referral in more detail. The manager said that he had seen the care plans for the person and that, if the referral progressed, he would conduct a full assessment of their needs using the organisation’s new tool. He said that as part of this the person would be offered more visits, and compatibility with other service users (taking into account their views) would be considered. The organisation has an admissions procedure. There is also reference to the admissions process in the Statement of Purpose. The manager said that he had recently turned down an emergency admission (respite) feeling that this would be too disruptive. He confirmed that he has the discretion to do this, and would only consider such a referral in particular circumstances. The manager is aware that the Statement of Purpose and Service Users Guide need revision, and intends to fully review these documents, forwarding copies to CSCI. Forest House DS0000016440.V293837.R02.S.doc Version 5.1 Page 9 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 the following standard(s): 6, 7 & 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A reasonable care planning framework is in place, although further development would help to provide clearer care plans, promoting consistency of approach as well as people’s independence. Service users are offered meaningful choices, helping them to feel more empowered and in control of their lives. Adequate risk assessments are in place, although there is scope for improvement, promoting clarity and more robust risk management. EVIDENCE: Care plans for two people were looked at in detail. Some person-centred care planning tools had been completed or partially filled in. Discussion with staff provided evidence of issues being taken forward, such as one person’s wish to ride in a hot air balloon. Both files had over 20 care plans in place. These covered appropriate areas and had been recently reviewed. However, there was discussion with the manager about whether guidance was clear enough Forest House DS0000016440.V293837.R02.S.doc Version 5.1 Page 10 and perhaps a little unwieldy. The quality of some care plan reviews was also discussed. For example, two recently reviewed care plans for one person appeared to contradict each other. One said that the person did not have a front door key (related to risk issues with going out unsupported) whilst a more recent plan described encouragement for the person to go out alone. The manager described plans to fully review and replace care plans once the company had introduced a new person-centred format (due shortly). It was agreed that it would be sensible to wait for this rather than make any major changes in advance. This will provide an opportunity to review long standing care plans which have headings such as ‘unable to control own finances’, to reconsider whether this is appropriate or whether there is scope for people to take on a greater degree of control and independence in areas such as this. Service users spoken with described being offered choices, such as about how they spend their time. Staff talked about how they offered choices, and how different people communicated their wishes. People living in the home were observed moving freely, and making decisions such as when they got up, what they had for breakfast and whether to have a drink/snack at any point. One person was observed making a choice about what to have for lunch. The laundry is routinely locked, although staff said that service users access the room with support and are encouraged to be as independent as possible in this area. Service users confirmed that they accessed the laundry. It was agreed with the manager that all significant restriction/limitations need to be documented/justified and subject to review, such as the laundry being locked. The possibility of some service users having their own keys could be explored. This area will be checked again in future inspections. Reasonable risk assessments covering appropriate areas were in place in the files checked, although there seemed to be duplication and some were also hard to read. The manager plans a full review of all risk assessments, including some monitored delegation to other team members. Forest House DS0000016440.V293837.R02.S.doc Version 5.1 Page 11 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 the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Appropriate support is provided for service users to take part in activities which reflect their needs and interests, helping them to lead full lives. Contact with family and friends is promoted, allowing people to maintain and develop important relationships. Service users’ rights are generally respected and routines are flexible, promoting people’s sense of autonomy, individuality and dignity. A balanced diet is provided which reflects people’s preferences, promoting service users’ health and quality of life. EVIDENCE: Service users had activity plans, providing evidence that they were supported to access a range of opportunities in the home and community. Person centred material also included reference to what people would like to spend their time doing. Daily records and observation, as well as discussion with staff and Forest House DS0000016440.V293837.R02.S.doc Version 5.1 Page 12 service users, provided evidence that people had varied, individual programmes which they were happy with. The manager and some staff commented that there was still work to do in this area but that progress had been made towards offering individual activities which met people’s needs. The manager would particularly like to see more evening activities, changing a pattern of people living in the home getting ready for bed relatively early. Some success has already been achieved, for example with evening trips to bingo which one service user was very enthusiastic about. The manager and staff said that the current vehicles (two cars) were not ideal for activity provision and that a people-carrier would offer more opportunities. This should be taken forward. Some staff pointed out that holidays were planned this year, for the first time in many years. Care planning files, daily records and discussion with staff and service users provided evidence that appropriate support is given for people to maintain and develop relationships with family, friends and others. Staff and service users described having flexible, individual routines, and this was observed throughout the inspection. Staff described how they promoted people’s independence. There was evidence that keys have been offered to people and that this is periodically revisited. Staff were heard asking one service user to have a cigarette outside rather than the smoking area due to a staff handover. The manager agreed that the staff should have found an alternative location rather than the service user being inconvenienced. The location of handover was discussed more generally. The smoking area is not ideal due to possible breaches of confidentiality (one service user’s room overlooks this area, and it is also used to access the laundry and a toilet). An alternative location should be found for handovers. Menus seen appeared to offer reasonable variety and balance. The manager reported that a dietician had recently visited the home. This had included checking the menu. The manager reported that, whilst making some observations, the dietician had praised the home’s menus. Staff described how service users were involved in food shopping and menu planning. Service users spoken with were positive about the food served in the home and confirmed that they could have alternatives to the set menu if they wished. Comments included that the food was ‘excellent’ and ‘nice’. Forest House DS0000016440.V293837.R02.S.doc Version 5.1 Page 13 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 the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good systems are in place for handling medication and appropriate support is provided with personal and healthcare needs, promoting service users’ dignity, health and wellbeing. EVIDENCE: Care plans referred to the support that people needed with personal care. Staff described how they offered this in a non-intrusive and respectful way. A temporary care plan in place whilst one person had a limb in plaster specifically referred to privacy and dignity issues. Staff described responding to people’s wishes around the gender of the person providing support. One person has a monitor in their bedroom with staff listening out in case of a seizure. The manager expressed some concern about this arrangement, though said it had been reviewed with the CLDT and that the service user themselves had expressed a wish for this form of monitoring to continue. Records provided evidence of people receiving appropriate routine and specialist healthcare. There was evidence of input from the Community Learning Disability Team. One person visited their GP on the day of the Forest House DS0000016440.V293837.R02.S.doc Version 5.1 Page 14 inspection. Another person was being supported to manage some dental pain and to access necessary input. Where appropriate people are encouraged to attend appointments on their own if they wish to. Some work has begun on Health Action Planning, though further development will take place in this area. Medication administration records and storage appeared to be in order. Protocols are in place for ‘as required’ medication, signed by the GP. It was pointed out that the allergy box on the MAR sheet should be completed, even if this is with ‘none known’. The manager described the training that some staff had received about the handling of medication. He plans to provide more training for staff in this area to develop people’s confidence and competence. This is good practice. Forest House DS0000016440.V293837.R02.S.doc Version 5.1 Page 15 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 the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Appropriate procedures and systems are in place for handling complaints, helping service users to feel listened to. Measures are in place which help protect service users from harm and abuse. EVIDENCE: Documents supplied to CSCI before the site visit provided evidence of the manager handling complaints appropriately, including thorough investigation, write-up and action. A series of complaints had also triggered a course of action to safeguard service users’ wellbeing and security. Complaints procedures are in place, including a symbol version. The manager and staff confirmed that service users have copies of these. Staff described how people with limited verbal communication expressed dissatisfaction and how they responded. Service users expressed general satisfaction with the systems for handling concerns and complaints but some indicated that they were reticent about making a complaint. This was conveyed to the manager, who will continue to promote a culture whereby people feel empowered to raise issues and receive a positive response for doing so. ABC charts provided evidence of staff using de-escalation techniques when appropriate. There was no reference to restrictive physical intervention. Behaviour management plans are in place for service users as necessary. The Forest House DS0000016440.V293837.R02.S.doc Version 5.1 Page 16 manager said that a number of staff needed training or refreshers in ‘CPI’ (the management of challenging behaviour) and adult protection, though explained that there had been some difficulties in accessing this. The home’s training matrix also identified these gaps for some staff. This will be looked at in future inspections and will be expected to be addressed. Staff spoken with confirmed their understanding of the whistle blowing policy, and said that they would report any concerns that they had. Service users’ finances were not checked on this inspection, but will be looked at during future visits. However, the manager said that when he had begun work in the home he had asked for an external financial audit. This had resulted in some refunds being made to service users. Forest House DS0000016440.V293837.R02.S.doc Version 5.1 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 the following standard(s): 24 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Significant improvements have been made to the environment, making it a homely, comfortable and attractive place to live, although there remains scope for further development. EVIDENCE: All communal areas were checked, along with some service users’ rooms (by invitation). Significant improvements have recently been made to the environment. This includes fully refitting the laundry and combining an upstairs toilet and bathroom and refurbishing this area. Some repainting has also taken place and protruding door hinges removed. Loose wiring near the front door has been boxed. Service users’ bedrooms were seen to be pleasantly decorated and personalised. People users expressed satisfaction with their rooms. One person wanted theirs painted pink. The manager was already aware of this and planned to take their wish forward. The manager also said that one person’s en-suite shower had been temporarily repaired, and that some work was planned to permanently improve this facility. Forest House DS0000016440.V293837.R02.S.doc Version 5.1 Page 18 The manager and some staff said that they would like the kitchen to be replaced as they felt the quality of the units was poor. It was noted that in one fridge the light bulb was not working and in the other a shelf had cracked. These issues need addressing as part of promoting general kitchen hygiene. Some service users smoke, and there is a designated smoking area. However, other areas of the home are smoky. This has been raised before, and was discussed with the new manager. One way to reduce the smoky atmosphere would be ask staff to smoke outside, in advance of a directive about this which the manager understands may come into force in the company in 2007. Consideration should also be given to finding an alternative smoking area which impacts less on the general atmosphere in the home, or to improving ventilation in the room. Some wallpaper was peeling away by the stairs. The manager said that this was due to wear and tear during recent building work and described plans to address this. Some new fire doors have been installed, and there are also plans to paint these and some areas around the frames as required. In addition, the manager intends to replace flooring in some rooms to make it more homely. It was agreed that a paper towel dispenser should be fitted in the first floor bathroom, although there are some difficulties about finding a suitable location for this. The manager said that the go-ahead has been received for refurbishing one bedroom which is particularly dark and dated. Quotes were being obtained for fitting TV aerial points in bedrooms to improve reception. The office remains cramped and is not entirely fit for purpose. The manager described longer-term hopes that an extension may be built which would provide additional communal space, extra accommodation and a new office. An outbuilding had a broken lock. It was agreed that this should be locked in view of potential hazards. The front door of the home is kept locked for safety and security reasons. However, one door to the car park from the garden was barred only with a tree stump. This is inadequate. If it has been assessed that a secure environment is required (including the back garden) then this makeshift solution must be replaced with something more suitable. As with the laundry, all limitations on people’s freedom will need to be documented and subject to review. The home appeared to be clean throughout. Forest House DS0000016440.V293837.R02.S.doc Version 5.1 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Progress is being made towards developing staff skills through training and qualifications, promoting competence and consistency of care, though there is scope for further improvement. Reasonable systems are in place for recruitment and selection, helping to reduce the chances of unsuitable carers being employed, although there is also potential for improvement in this area. EVIDENCE: The manager reported that two staff out of 10 had qualifications in NVQ care (besides himself), although four were on the course and others were interested in starting. However, difficulties with getting work assessed were slowing progress. It is acknowledged that efforts have been made to take this forward, but that delays beyond the home’s control have been encountered. Staff spoken with demonstrated a reasonable understanding of people’s care plans, care needs and conditions. Some people said that they would like some more training in working with people with mental health difficulties. This was put to the manager, who agreed to consider how this apparent training need could best be met. Forest House DS0000016440.V293837.R02.S.doc Version 5.1 Page 20 One aspect of standard 32 is about professional relationships with others involved in service users’ care (32.3 – vii). Whilst much positive feedback was obtained through comment cards some constructive criticism was made. Two health & social care professionals indicated that the home did not always communicate clearly and work in partnership with them. There were also suggestions that professionals were not always notified of significant events affecting their client’s wellbeing, that training was not being sufficiently prioritised, that the overall working relationship was not as good as it could be, and that there was a reluctance to pay for any specialist/extra clinical input. High turnover of managers was cited as one contributory factor, so it may be that there will be an improvement now that stable management is in place. It is difficult for CSCI to comment on this feedback, but clearly there are issues here which need to be discussed and resolved. See also Standard 39. Service users spoken with were positive about the staff, indicating that they were nice, friendly and gave them the help that they needed. Three staffing files were checked and appeared to be generally in order. However, it was suggested that for one person an alternative referee should have been sought. The manager had also been conducting interviews alone. This was for expedience, but the manager was aware that this was not good practice, and intends to have at least one person interviewing in future. One person had a gap in their employment history (June 2004 to March 2005). The manager said that this had been discussed in interview. However, the Care Homes Regulations require that that there is a written explanation of this. Workbooks for induction and foundation were viewed. These were very detailed and were linked to Skills for Care and LDAF standards. Some answers completed by staff needed further exploration. The manager was due to review some workbooks to check on the quality of responses and to ensure that the assigned mentors were fully competent to support staff through the process. The manager said that many staff would soon need refresher training in certain areas. He had arranged training in fire safety and moving & handling for June 2006, which would cover much of this. He also plans to conduct training in health & safety and Coshh using a company manual. In addition, the manager plans some epilepsy awareness training. Food hygiene training remains externally provided. As noted, there are some difficulties in accessing refresher training in CPI and adult protection. The company has a training coordinator who supplies information about future courses, venues and availability. A training matrix was supplied. This provided further evidence of training completed and due. Whilst some gaps remain in key areas, the manager has clear plans to arrange all necessary training subject to availability and it is anticipated that this standard should be met by the next inspection. Forest House DS0000016440.V293837.R02.S.doc Version 5.1 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well run, promoting positive outcomes for service users. Good frameworks and systems are in place for monitoring and improving the quality of care provided, helping service users and others involved in their care to feel that their feedback counts. Whilst some areas still need attending to, effective systems are in place for identifying and managing health & safety issues, promoting the wellbeing of service users and staff. l EVIDENCE: Staff gave positive feedback about the manager. Comments included that he was encouraging the service users to be more active (particularly in the evenings) and that he was very fair and approachable. Service users were also positive about the manager. Forest House DS0000016440.V293837.R02.S.doc Version 5.1 Page 22 The manager has applied to register and at the time of writing the application was being processed. He has qualifications and experience appropriate to the role, and is hoping to take a relevant postgraduate course. Quality assurance was discussed. The manager said that a relatives’ survey had just been completed, and that this may be extended to advocates and others. Given the comments received by CSCI (see ‘Staffing’ section) it would seem appropriate to conduct a wider survey in order to establish where the home could improve and to begin a dialogue where necessary, as well as to obtain positive feedback. The manager said that a service users’ survey was also planned. Service users spoken with felt listened to. Some commented on the residents’ meetings. Minutes from one meeting on April 21st 06 were seen, providing evidence that a range of topics were covered and that service users contributed to the discussion. The company has a number of internal and external quality assurance/audit systems, covering health & safety, care, medication and finances. As noted, the manager had initiated a financial audit upon his arrival. He had also undertaken some internal audits resulting in detailed action plans covering areas such as health & safety and staffing issues. Regulation 26 reports are being forwarded to CSCI, although none have yet been received in the new format being used from March 2006. A copy was seen on file in the home. Staff spoken with felt that the home was a place to work and to live. As noted, the manager plans to train staff about health & safety using materials produced by the company. A self-learning pack was viewed and was very detailed. The organisation has a health & safety policy. The recent health & safety audit had resulted in some shortfalls being identified, although overall the home still passed according to the thresholds set by the company. As noted, an action plan has been generated. This demonstrates that the system is effective at highlighting shortfalls, and that the manager has been proactive in planning to address these. The fire log was checked and appeared to be fully in order. Regular fire drills take place. In the last report a requirement had been made about ensuring that hot water temperatures in the home were at an appropriate level. A record of basin readings for May 2006 showed that temperatures were reasonable, although shower temperatures had recently been measured at 48°C, which was agreed as being on the high side. The manager added that some outlets produced inconsistent readings. He said that work was due to start in the next couple of weeks to address the issues around variable/high water temperatures. Forest House DS0000016440.V293837.R02.S.doc Version 5.1 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 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 3 23 3 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 2 33 x 34 2 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 2 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 x x 2 x Forest House DS0000016440.V293837.R02.S.doc Version 5.1 Page 24 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 2 Standard YA24 YA24 Regulation 13(3) Requirement Timescale for action 15/07/06 30/06/06 3 YA34 4 YA42 Attend to the issues with the fridges as noted in text. 12(1) If it has been assessed and 23(2) documented that a secure environment is required (including the back garden) then the doorway from the garden to the car park (barred with a tree stump) must be secured. 19(S.2(6)) Ensure that there is a satisfactory written explanation of any gaps in employment for people working at the home. 12 (1) a & Ensure that hot water 13 (4). temperatures are at an appropriate level for each outlet (including showers) depending on the outcome of temperature readings and risk assessments. (timescales of 31/10/05, 20/12/05 and 28/02/06 not met). 30/06/06 15/07/06 Forest House DS0000016440.V293837.R02.S.doc Version 5.1 Page 25 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 YA6 Good Practice Recommendations Consider whether care plans reviews are being conducted appropriately (see, for example, notes in the text about two recently reviewed care plans which were apparently contradictory). Consider replacing one of the cars with a people carrier in order to be able to provide more opportunities for service users to take part in activities in the community. Find an alternative location to the smoking area for handovers which minimises the risk of breaches of confidentiality and where service users are not inconvenienced. The allergy box on the MAR sheet should be completed, even if this is with ‘none known’. Ensure that staff receive training/refreshers as required in the management of challenging behaviour and in adult protection. Ask staff to smoke outside (in advance of a directive about this, understood to be due in 2007). Consideration should also be given to finding an alternative smoking area which impacts less on the general atmosphere in the home, or to improving ventilation in the room. Repair the broken lock on one outbuilding. TV aerial points should be fitted in each bedroom in order that service users have a good reception on their televisions. Although not implemented there was evidence of this being taken forward. A paper towel dispenser should be fitted in the first floor bathroom. Consider how training needs in mental health issues identified by the staff could best be taken forward in a way which is appropriate to the role/setting. Conduct a broad survey of people involved in service users’ care, as noted in the text, to identify development areas as well to obtain positive feedback. 2 3 YA12 YA16 4 5 6 YA20 YA23 YA24 7 8 YA24 YA26 9 10 11 YA30 YA32 YA39 Forest House DS0000016440.V293837.R02.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Gloucester Office Unit 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 DS0000016440.V293837.R02.S.doc Version 5.1 Page 27 - 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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