Inspection on 31/05/07 for Four Nevill Park

This inspection was carried out on 31st May 2007.

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 no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Four Nevill Park 30/09/09

Four Nevill Park 09/07/08

Four Nevill Park 29/08/06

Four Nevill Park 08/02/06

Four Nevill Park 29/09/05

Four Nevill Park 04/01/05

Four Nevill Park 13/05/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Four Nevill Park 4 Nevill Park Tunbridge Wells Kent TN4 8NW Lead Inspector Anne Butts Key Unannounced Inspection 31st May 2007 10:30 Four Nevill Park DS0000023940.V337486.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 Four Nevill Park DS0000023940.V337486.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. Four Nevill Park DS0000023940.V337486.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Four Nevill Park Address 4 Nevill Park Tunbridge Wells Kent TN4 8NW 01892 519520 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) Evesleigh (Kent) Limited Vacant Care Home 24 Category(ies) of Learning disability (24) registration, with number of places Four Nevill Park DS0000023940.V337486.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th August 2006 Brief Description of the Service: Four Nevill Park is a large detached Victorian property standing in its own grounds situated in a private road in an elevated position. It is registered for 24 service users and has been developed to offer care for people with a diagnosis of Autism or Aspergers Syndrome. It is set out over four floors and is divided into three units. There is also accommodation for people in semi-independent flats and these are located around the building. The home is located on the outskirts of Tunbridge Wells; the town centre is a short distance away with easy access to public transport. Shops, pubs, post office and church are within easy walking distance of the home. There are large gardens, mainly laid to lawn, to the front and rear of the home that can be used by service users. There is car parking to the rear of the building. The current fees range from approximately £800.00 to £1900.00 per week. Four Nevill Park DS0000023940.V337486.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a Key Unannounced inspection that took place in accordance with the Inspecting for Better Lives (IBL) process. Key inspections are aimed at making sure that the individual services are meeting the standards and that the outcomes are promoting the best interests of the people living in the home. The IBL process for a Key inspection involves a pre-inspection assessment of service information obtained from a variety of sources including an annual selfassessment and surveys. It is now a legal requirement for services to complete and return an Annual Quality Assurance Assessment (AQAA). This assessment is aimed at looking at how services are performing and achieving outcomes for people. Judgements have been made with regards to each outcome area in this report, based on records viewed, observations and verbal responses given by those people who were spoken with. These judgements have been made using the Key Lines of Regulatory Assessment (KLORA), which are guidelines that enable The Commission for Social Care Inspection (CSCI) to be able to make an informed decision about each outcome area. Further information can be found on the CSCI website with regards to the IBL process including information on KLORA’s and AQAA’s. The actual site visit to the service was carried out over one day by two inspectors, who were in the home from approximately 10.30 in the morning until 4.30 in the afternoon. The main focus of the visit was to review any improvements made since the last visit and the well being of the service users. Time was spent touring the building, talking to people living in the home, talking to staff and reviewing a selection of assessments, service user plans, medication records, menus, staff files and other relevant documents. Prior to the site visit the AQAA had been returned and surveys had been sent out to service users, families and professionals to gain further feedback as to their opinion of the service. A number of surveys have been returned. Since the last visit a new Manager is now in place and Evesleigh (Kent) have become part of a larger provider organisation (ILG). At all times the manager and staff were helpful and demonstrated a pro-active approach to ensuring that service users were being supported to the best of their abilities and resources. This report contains evidence and judgements made from observation, conversation and records. People living in the home were keen to talk to us and the majority of comments were positive with service users confirming that they felt supported. Four Nevill Park DS0000023940.V337486.R01.S.doc Version 5.2 Page 6 Comments from relatives and professionals received were mainly positive including “They support my son in everyway and in doing so show considerable patience for his disabilities”. “There is a very good staff team at the moment and they are working really hard with the residents”. “They all want the best for the clients”. “The support is very good, but it would be nice to see some more activities in the home”. “This is a pleasant home which is friendly, caring and well run”. “I am always very impressed with the care given to my client and over the years it has always been consistent”. An open day has been arranged for 23rd June 2007 for families and friends to meet. What the service does well: What has improved since the last inspection? Staff have now been trained in Adult protection protocols and are aware of the importance of safeguarding the people living in the home. Other training is still currently ongoing. Four Nevill Park DS0000023940.V337486.R01.S.doc Version 5.2 Page 7 The layout of the building has undergone considerable refurbishment and all people living in the home spoke positively about the changes. More members of staff are now enrolled in an NVQ training programme. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Four Nevill Park DS0000023940.V337486.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 Four Nevill Park DS0000023940.V337486.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, 3, 4 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a comprehensive assessment of their needs prior to moving into the home to ensure their assessed needs can be met. They also benefit from the opportunity to visit the home prior to admission to assess the quality, facilities and suitability of the service. People do not however benefit from contracts that serve to fully protect their individual rights and make sure that they are being provided with the service that the fees are being allocated for. EVIDENCE: Although the Service Users Guide was not reviewed at this visit an updated edition had been previously sent to the CSCI, and there is a version in pictorial format. Records for service users viewed showed that they all had copies of the Guide in their personal files – although some people, who may benefit, did not have copies in the pictorial format. It is being recommended that the Home makes sure that all service users have an up to date copy of the Guide, and consideration could be given for people to have copies in their own rooms should they so wish. Four Nevill Park DS0000023940.V337486.R01.S.doc Version 5.2 Page 10 A selection of records was viewed for people living in the home and these showed that there is a pre-assessment process in place. Further involvement in these assessments included Care Managers and families or advocates where appropriate. Of the records viewed these assessments were seen to be comprehensive and holistic in their approach, although it is recommended that the home give consideration to including a section on developing and maintaining family, friends and personal relationships and how the home can support people with this. Prior to moving in people are given the opportunity to visit the home and meet people already living there – conversations with service users and records viewed all showed that this occurs. The home is set out in three units over the different floors, with the addition of the semi-independent flats. These units have dedicated staff that work closely with the people living in each area and each unit accommodates people with similar disabilities and needs. Evidence including observations, records and conversations with staff and service users showed over the course of the site visit that staff in all the units worked closely with individual people and interacted well with genuine positive regard between all parties. Examples included: • One service user, who had no verbal communication skills and needs oneto-one support – observation demonstrated that the carer treated this person with respect and sensitivity and was also able to respond to the service users needs. Further conversations with the member of staff also supported the awareness of how to support this person. Another service user living in the one of the semi-independent flats described how he was able to manage his own care and his own flat, but admitted that he “was not always as clean and tidy as he should be” and that staff would sometimes talk to him about this but they “would not come into my home without my permission”. Subsequent conversations with members of staff also demonstrated how they would work with this person in order to help maintain a safe environment without invading his privacy. • All records viewed and conversations with different people living in the home evidenced that they have access to an independent advocacy service. One service user did state that they felt that the advocates were ‘more interested in writing letters than helping sort out any day to day problems in the home’ – and the Manager was advised to ensure that the role of the advocates was fully explained and to make sure that the advocates supported individuals with their needs. The Manager did acknowledge that there was some outstanding training that needed to be addressed in order to fully support people – but she has only been in position for just over two months and a new provider organisation has only been in position since just before Christmas 2006, and these are being Four Nevill Park DS0000023940.V337486.R01.S.doc Version 5.2 Page 11 addressed (further observations are recorded in the Staffing section of this report). There are contracts in place and they state basic information such as fees and room / flat accommodation, and do work in conjunction with the Statement of Purpose and Service Users Guide. They do not however individualise as to the amount of support that will be provided with regards to the fees that are being paid for people, and are not in a format that all service users would be able to be acquainted with. It is acknowledged that there was only a selection of contracts viewed but a requirement is being made that all individual contracts state as to the exact amount of support people should be receiving in accordance with the fees that are being paid and that it is in a format that individuals should be able to identify with. Four Nevill Park DS0000023940.V337486.R01.S.doc Version 5.2 Page 12 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, 8 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from having individual plans that are comprehensive, identify needs and personal goals and are specific to the individual. They are supported by detailed risk assessments. EVIDENCE: All records viewed showed that there is an individual plan in place for people, and these were seen to be very in-depth. The care plans are comprehensive and include all aspects of personal and social support. Information and advice from health care professionals is incorporated into the plan. Care plans have been agreed with relatives and people using the service where possible. Evidence of regular reviews was seen. The care plans contain a substantial amount of detail, but the home does need to ensure that the detail as to how they support people on a day-to-day basis does not become ‘hidden within too much information’ and that the guidelines are clear and direct. Four Nevill Park DS0000023940.V337486.R01.S.doc Version 5.2 Page 13 The plans are individual to different needs and include a statement from each person about who they are and an over-view written by each person about their likes and dislikes and their circle of support. There was detailed guidance on how to support people in different areas of their life including their individual goals and aims, and guidelines for individual procedures when supporting people who may show aggressive tendencies or be vulnerable to self-harm. There are regular key-worker meetings in place and any changes to individual goals or aspirations were incorporated into the care plans. Service users are fully supported in making their own decisions and taking control over their own lives. Several service users described how they were supported in their daily lives and that they were able to choose what they wanted to do. Care plans and risk assessments supported people in their chosen activities. The records for one service user showed that he wanted to able to travel to college on his own and a programme had been put into place to support him in being able to manage this. People living in the home have opportunities to participate and have a say in the running of the home. Regular monthly meetings are held with people and these allow service users to have a say in different aspects. There are comprehensive risk assessments in place for individual people, and these were tailored to their needs and are aimed at supporting people with maintaining their independence. Risk assessments cover both environmental and individual risks and are linked in with the care plans. Where changes had been identified these had been incorporated into the care plans. Four Nevill Park DS0000023940.V337486.R01.S.doc Version 5.2 Page 14 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, 14, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a strong commitment to enabling service users to develop their skills, including social, emotional, communication and independent living skills, and people benefit from a flexible routine that meets their individual needs. Some service users would benefit further from the Home making sure that their individual preferences with regards to activities or support are better met. Service users benefit from having opportunities to be involved in food shopping, menu planning and meal preparation. EVIDENCE: People living in the home are supported to take part in a wide range of activities, work and educational opportunities. Care plans demonstrated how people are supported in accessing their individual choice of daily activities. Many people attend college courses and one service user (who had only just Four Nevill Park DS0000023940.V337486.R01.S.doc Version 5.2 Page 15 moved into the home) stated that he had wanted to go to college and that the staff had helped him arrange this. All service users participate in a range of activities including rock climbing, using local leisure facilities, swimming, shopping, pub and cinema trips. One service user also regularly helps out in the reception office by meeting people who visit and answering the phone. He confirmed how much he enjoyed this. It was noted that one service user was not able to access one of her preferred activities and this had been a direct result of insufficient staffing to support her in this, as there was not sufficient female staff to accompany her. Records showed that for certain activities she was funded for two - one support, the Manager stated that she did not think that this was the case, although reviews stated that this support was in place. It was strongly recommended that the funding arrangements be investigated for this service user and that her activities programme be reviewed in line with this. Service users are supported with life skills such as cooking, household chores and daily living tasks to promote and maximise their independence. The extent to which they are supported varies according to individual needs. Service users mainly confirmed that they were only given the support that they felt they needed and that staff respected their own wishes. Care plans supported the level of care provided. One service user did state that he was sometimes unhappy with the amount of support provided and felt that staff could compromise his privacy – records did show that the home were aware of his concerns and had responded appropriately to his concerns, but as yet he was still unhappy with certain aspects of the service. The home is working closely with other professionals and the individual to aim to address these. Observations made during the course of this visit showed that people had choices and freedom of movement. There are routines but they are flexible to individuals and are there to support people. All people could have a key to their own flat or room if they wished and this was recorded in their plans. People are supported to maintain family links and friendships and people are able to choose to meet their friends and family in private. As stated earlier in this report – the assessment process would benefit from acknowledging supporting people with relationships and the outcomes of these would further benefit service users by being fully incorporated into their care plans. Staff promote and encourage healthy eating and work with service users in devising menus. Service users receive support to cook and shop, and the amount of support they required was identified in their care plans. Sunday lunch is quite a social affair with people on the same floor, including the people living in the independent flats, preparing and sitting down together to have their meal, if they should so wish. Records showed that special diets are catered for and if people want to keep records of their menus and meal planning they are encouraged to do so. Four Nevill Park DS0000023940.V337486.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 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The personal and health care needs of people are well met, promoting and protecting their, dignity and independence. There are polices and procedures in place for medication but service users are not adequately protected by the administration and recording of medication. EVIDENCE: Care plans showed that people are only assisted with their personal care if they need it. Personal support is mainly through gentle prompts and people are supported and encouraged to make independent choices about their care and personal routines. The majority of service users are able to express and communicate their wishes and those who spoke to the inspectors were very clear about their choices and decisions. Comments included “I like it here, staff do not make me do anything I don’t want to”. “I am very happy – staff only help me when I ask”. Four Nevill Park DS0000023940.V337486.R01.S.doc Version 5.2 Page 17 Records demonstrated that individual healthcare needs are well met with people being supported in going to health care appointments including the dentist, opticians and GP appointments along with any specialist appointments. All service users are given the opportunity to manage their own medication within a risk assessment framework. Some service users maintain medication in lockable cabinets in their rooms and others have opted to keep their medication in the main medication storage facilities on the individual floors. For the individuals who have chosen to manage their own medication there is a pictorial risk assessment format in place, which has been completed by the individual to support their capacity to manage their own medication. Although medication is reviewed at the monthly key-worker meetings there was no evidence to support any updates on individuals’ capacity to self-administer. It is being recommended that this should be reviewed on a more regular basis. Medication records were viewed on two of the three units. There were policies and procedures in place and sample signatures of people signing. In one of the units two people were signing the Medication Administration Record (MAR) sheets, and the senior was advised that this is not recommended good practice and that only one person should sign the sheet. There were also some gaps in the MAR sheets for one service user, with no explanation as to why the medication had been missed. The senior resolved to look into this immediately. There was clear guidance for individuals with regards to the PRN (which is as and when medication such as paracetamol). Some staff stated that they had received training in medication, but training records showed that that there was still a high percentage of staff that needed training in the administration of medication, although it should be noted that the Manager is aware that there are training issues that need addressing as a matter of priority. Four Nevill Park DS0000023940.V337486.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 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users can be confident that their complaints will be listened, taken seriously and acted upon, although not all service users are aware of how to make a complaint. Service users are safeguarded by adult protection policies and procedures and staff who are trained protect them. EVIDENCE: There is a complaints procedure in place, and this is available for all service users. It is in a pictorial format with the pictures of the manager and area managers on display. There have been changes in the staff structure and the complaints procedure does need to be updated to reflect this. Staff stated that both key worker and house meetings allowed for people to air their views. The majority of people stated that they knew how to make a complaint, although comments returned in the surveys did state that some people were not sure who they could complain to – it is being recommended that as the complaints procedure is updated then it is discussed with the people living in the home to make everyone fully aware of the procedure. Three complaints were viewed and although they had been passed to the appropriate person, there was not a full audit trail to evidence final outcomes and if the complaint has been resolved satisfactorily. The home needs to ensure that their records are robust. Four Nevill Park DS0000023940.V337486.R01.S.doc Version 5.2 Page 19 There have been no adult protection issues raised since the last visit, and staff have recently had updated training in adult protection issues with the majority of staff having undertaken this. In one unit all the people living on this floor have agreed for their personal allowances to be locked away, and they can access it when they want. The records for keeping money safe were robust. Previous inspections had identified that the home was acting as an appointee for some service users, and as yet no action has been taken to resolve this – it is being recommended that the home continue to look for alternative solutions for this. Four Nevill Park DS0000023940.V337486.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, 26, 28 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has been refurbished for the benefit of service users and people have access to safe and comfortable indoor and outdoor communal areas. People are benefiting from living in a home that suits their lifestyles. EVIDENCE: The home is situated in a quiet private road just outside the centre of Tunbridge Wells. It stands in its own gardens with private car parking space. The property is set out over four floors and has been arranged into three units. Alongside these units there are a number of semi-independent flats. During the past twelve months the home has undergone substantial refurbishment and the last report commended the home in the support of service users during this period. Comments from relatives confirmed that the refurbishment had been for the benefit of people living in the home and these included Four Nevill Park DS0000023940.V337486.R01.S.doc Version 5.2 Page 21 “The building works have made a tremendous difference to the people living in the home”. “The home is so much better now they have done the refurbishment”. All the communal areas on the different floors were decorated in a homely and comfortable manner, although the Manager stated that the lounge on the ground floor was still in need of redecorating and that this was being addressed. She also stated that the bathrooms were scheduled in for being improved and some work had already started on this. Each floor also has its own kitchen and laundry and people are supported in using these. People living in the home all stated how they liked their own personal space and any viewed all showed that they had been personalised with their own possessions and choice of furnishings. Four Nevill Park DS0000023940.V337486.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): 31, 32, 33, 34 and 35. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users can be confident that they are supported by caring staff that respect their choices and preferences, although they will further benefit when staff have received appropriate training. Staffing levels do not always allow service users to be supported in routinely taking part in their calendar of activities. EVIDENCE: Staff spoken to and observations made demonstrated that they were very focussed on the needs of the people living in the home and that they worked closely with the people living there. The home continues to operate a keyworker system and the home has now been divided into three units, set over the different floors that are allocated a staff group. Occasionally there is some movement of staff between units/floors to cover sickness or annual leave, but overall the staff groups remains stable providing continuity of care to individuals. There is a full staff handover with seniors from each unit taking part so that they can be aware if there is any particular needs that they should Four Nevill Park DS0000023940.V337486.R01.S.doc Version 5.2 Page 23 be aware of, and in this way different areas of the home do not become isolated from each other. Service users spoke highly of people working in the home and there was a good rapport between staff and service users. Comments from relatives also supported the staff team with one relative stating, “There is a very good staff team here”. Service users also commented on the support from staff and comments included “They (staff) always listen to me and treat me well” and “There is nothing bad about this home everyone treats me really well”. As the staff teams work on the individual floors the staffing ratios are worked in accordance with people who live in the different units, with a higher staffing level where service users need more support. Although the service appears to be staffed adequately to enable key support needs for people’s daily support to be met, staff rotas do not evidence this in all of the different areas. Where the Manager was able to show that staff had been on duty, there were still occasional instances in the top unit that evidenced that there had been times where there had only been one on duty when there should have been two. Also the basic staffing levels did not always enable service users to undertake routinely their calendar of activities and examples of this were seen in daily notes that included not being able to support one service user with her preferred activity (as identified earlier in this report) and also a service user had not been able to be escorted shopping due to inadequate staffing levels. Requirements are being made that the staff rotas accurately reflect who has been on duty and that staffing levels must be reviewed to allow for support for people in accessing their chosen activities as identified within their care plans. Records viewed for the newest member of staff who had been employed since the new Manager took up post showed that all records and pre-employment checks are in place. This includes appropriate references and a Criminal Records Bureau (CRB) check and Protection of Vulnerable Adults (POVA) check. There is an induction programme in place and this is in line with Skills for Care, new members of staff complete a workbook and this is reviewed by a senior member off staff, it would benefit new members of staff if this was ‘signed off’ on a regular basis. Staff also shadow senior members of staff during their initial period of employment and are supported in getting to know service users and their individual needs. The Manager stated that since she had taken over responsibility for the home and she has been reviewing the training needs and has identified that there were some substantial shortfalls. She has already taken some steps to address this, with staff recently having completed Adult Protection, First Aid and Fire safety. Staff stated that they had recently benefited from training and felt that the support from the new provider organisation was proving to be beneficial. There is a training matrix in place that has identified where any shortfalls are. The training programme needs to continue and makes sure that Four Nevill Park DS0000023940.V337486.R01.S.doc Version 5.2 Page 24 it focuses on the key areas that will promote the good care for this service user group. Staff meetings are being held regularly and the Manager is using the meetings to make sure that staff are fully up to date with different polices, procedures and current good practice. Four Nevill Park DS0000023940.V337486.R01.S.doc Version 5.2 Page 25 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, 38, 39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a manager who is clearly committed to safeguarding and promoting individuals independence, rights and choices and is assisted by a stable staff team who offer a good support to the service users. EVIDENCE: The manager has been in post for just over two months and has a background in working in the care environment, particularly with people with autism and challenging behaviour. She stated that she has achieved her NVQ4 and her Registered Managers Award. She has overall responsibility of the running of the home and is supported by a Deputy Manager and Senior support workers. Four Nevill Park DS0000023940.V337486.R01.S.doc Version 5.2 Page 26 Observations showed that there was an open and positive ethos approach to the home with good interaction between all members of staff and the people living in the home. Comments from professionals who returned surveys included “The communication with Nevill Park has been excellent and they have a calm approach to managing challenging behaviour”. “The care is well balanced with people being supported in recognising boundaries” Regular monthly visits are carried out by a senior member of the management team and this includes reviewing of health and safety around the home and also talking to service users and gaining their perspective on the service that they being supported with. Any formal quality assurance processes were not reviewed at this visit, although the manager, staff and service users all stated that there are regular meetings where people can put their views forwards and there are also opportunities for more private discussion through key worker meetings and supervision. The last visit identified that there was a need for a more formal quality assurance process to be put into place with an annual report provided. As previously stated since that visit there has been a new Manager and provider organisation in place and there current systems should allow for this to be developed. The majority of records viewed were well maintained with up to date information contained, one exception was some of the rotas and as stated earlier in this report they did not identify as whether there were worked or not, the home needs to make sure that these are maintained accurately. The returned AQAA identified that the majority of safety checks had been carried out, although testing for portable electrical appliances hadn’t been done, as part of their maintenance routine the home should make sure that this is carried out. Four Nevill Park DS0000023940.V337486.R01.S.doc Version 5.2 Page 27 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 3 4 3 5 1 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 3 27 X 28 3 29 X 30 3 STAFFING Standard No Score 31 3 32 2 33 2 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 3 2 X 2 3 X Four Nevill Park DS0000023940.V337486.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No 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 YA5 Regulation 5 (b) (c) Timescale for action The registered person must 31/07/07 make sure that people living in the home have a contract that states all their terms and conditions including exactly what the support they are being provided with within the agreed fees. The registered person must 31/07/07 make sure that the arrangements for the recording, handling and safe administration of medication is maintained in that: Only one person should sign the MAR sheet. Any gaps in MAR sheets should identify as to why the medication has not been administered. Staff who administer medication must be in receipt of appropriate training. Staffing levels must reflect the 31/07/07 needs of the service users in that there is sufficient staff to support people with their programme of activities. Clear records of staff rotas must 15/07/07 be maintained, and whether the rotas was actually worked and DS0000023940.V337486.R01.S.doc Version 5.2 Page 29 Requirement 2 YA20 13 (2) 3 YA33 18 (1) (a) 4 YA41 17 (2) Sch 4 (7) Four Nevill Park identify any changes clearly and accurately. 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 YA1 Good Practice Recommendations It is recommended that the home makes sure that all service users have an up date copy of the Service Users Guide in a format that is suitable for their needs. Consideration could be given to people having copies of this available in their own rooms should they so wish. It is recommended that the home consider expanding its initial needs assessment to include a section that explores how to develop and maintain family and personal relationships for service users. It is recommended that the complaints procedure is updated and then re-issued to all service users so that they are fully aware of who they can complain to. It is very strongly recommended that the home seek possible alternatives for appointees for service users who have the staff of the home act as their appointee for their finances 2 YA2 3 4 YA22 YA23 Four Nevill Park DS0000023940.V337486.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Four Nevill Park DS0000023940.V337486.R01.S.doc Version 5.2 Page 31 - 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!