Inspection on 23/06/08 for Fraser Drive

This inspection was carried out on 23rd June 2008.

CSCI found this care home to be providing an Adequate service.

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 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Fraser Drive 17/05/06

Fraser Drive 10/11/05

Fraser Drive 12/05/05

Fraser Drive 23/03/05

Fraser Drive 05/07/04

Fraser Drive 09/02/04

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOME ADULTS 18-65 Fraser Drive 9 & 11 Fraser Drive Woodseats Sheffield South Yorkshire S8 0JG Lead Inspector Beverly Hill Key Unannounced Inspection 23rd June 2008 09:15 Fraser Drive DS0000002959.V366821.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 Fraser Drive DS0000002959.V366821.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. Fraser Drive DS0000002959.V366821.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fraser Drive Address 9 & 11 Fraser Drive Woodseats Sheffield South Yorkshire S8 0JG 0114 274 5033 0114 274 5033 none www.dimensions-uk.org Dimensions (UK) Ltd Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Carol Loftus Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Fraser Drive DS0000002959.V366821.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th May 2006 Brief Description of the Service: Fraser Drive is a purpose built home for adults with learning disabilities aged between 18-65 years. The home is in a residential area of Sheffield with good access to public services and amenities (e.g. bus services, shops, libraries etc). People live in two separate detached houses that share the same grounds. Each house has six single bedrooms, based on the ground floor, a communal lounge and dining room and a domestic style kitchen. Number 11 Frazer Drive also has an activity room well stocked with books and games. Each house has combined bathroom and shower room and a further unassisted bathroom. The garden encompasses both houses at the back of the property and is well tended and secure. There are accessible lawned and paved areas, a variety of seating and a greenhouse. There is a small car park to the front of the building. The houses are well presented and well maintained. According to information received the weekly fees can range up to £1199.50p depending on assessed need. Information regarding the services provided was included in the homes statement of purpose and service user guide. Items not included in the fees are hairdressing, chiropody, toiletries, clothing, TV license and outings. There are other items that people are expected to pay for which include, holidays and decoration and refurnishing of individual bedrooms. Fraser Drive DS0000002959.V366821.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. This inspection report is based on information received by the Commission for Social Care Inspection (CSCI) since the last key inspection of the home on 17th May 2006. The report includes information gathered during a site visit to the home, which lasted approximately eight hours. Throughout the day we spoke to several people that lived in the home to gain a picture of what life was like at Frazer Drive. We had discussions with a senior staff member on duty, as the manager was unavailable on the day, and care staff members. Information was also obtained from surveys received from eight people that lived in the home, three relatives and seven staff members. Comments from the surveys and discussions have been used throughout the report. We looked at assessments of need made before people were admitted to the home, and the home’s care plans to see how those needs were met while they were living there. Also examined were medication practices, activities provided, nutrition, complaints management, staffing levels, staff training, induction and supervision, how the home monitored the quality of the service it provided and how the home was managed overall. We also checked with people to make sure that privacy and dignity was maintained, that people could make choices about aspects of their lives and that the home ensured they were protected and safe in a clean environment. We observed the way staff spoke to people and supported them, and checked out with them their understanding of how to maintain privacy, dignity, independence and choice. Since the last visit there has been no formal complaints or concerns raised with the Commission for Social Care Inspection. Since the last visit there have been some incidents between people that live in the home. These have not been referred to the safeguarding of adults team as the policies and procedures dictate. See the section on complaints and protection. We would like to thank the residents, staff and management for their hospitality during the visit and also thank the people who completed surveys. What the service does well: Fraser Drive DS0000002959.V366821.R01.S.doc Version 5.2 Page 6 People live in a purpose built home that is suitable for their needs and all of the people have a single room that is nicely personalised to their own taste, providing them with a private area to their liking where they can spend private time or receive visitors. The home was a clean, accessible and well-decorated environment for people. Those spoken with were very happy with their bedrooms. People had their needs assessment by staff and these were kept updated. Everyone had a good care plan that gave guidance to staff on how to support people. This was important to ensure that care was not missed. Care plans were written in a way that was individual and included the way that people liked to be treated and helped. A lot of the staff had worked at the home for some time and knew the residents well. They helped people to make their own decisions about aspects of their lives and encouraged them to keep in touch with their families. Staff supported people to keep active and access community facilities. People liked the meals provided and were encouraged to eat a healthy diet but also to eat foods that they liked. The kitchen was well stocked with food. The staff ensured that people felt able to complain and had standards of support they abided by. These included respecting peoples’ privacy and asking people to do things rather than telling them. A good recruitment policy is in place so that staff members employed are safe to work with the people that live in the home. New staff are inducted well and receive supervision from senior staff to make sure they monitored in their role. What has improved since the last inspection? What they could do better: Fraser Drive DS0000002959.V366821.R01.S.doc Version 5.2 Page 7 The information for people must be up to date and say what people are expected to pay for, if they cannot speak up for themselves relatives/advocates must be asked for them before agreements are made. The individual care plans need to be reviewed every six months so the information is continually checked and up to date. People must be consulted about whom they wish to live with, as some people do not get on and this causes friction between them. On some occasions people have been hurt during incidents, which has affected their health and emotional wellbeing. When incidents affecting their welfare occur between people the staff must inform the local authority and the Commission. This will ensure that the incidents can be checked out straight away and a decision made about how to address them. The way the staff members manage medication must be improved so that it is recorded and signed for consistently, and made safe when people take some of it with them to day services. All staff must be provided with further special training, e.g. mental capacity act, safeguarding adults, accredited medication and how to manage behaviours that could be challenging to help them to meet the special needs of people. Some staff members have completed a qualification (NVQ Level 2), which says they know how to work with the people in the home and how to meet their needs, but the percentage of staff having completed it could be improved. The system that helps to improve the standards in the home must work better so that people and their relatives are consulted about how the home is managed. Staff that work in the home and professionals that support the home should also be asked their views. The manager needs to check out some health and safety issues so that the home is safe and secure for the people that live there. 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. Fraser Drive DS0000002959.V366821.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 Fraser Drive DS0000002959.V366821.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): 1, 2 and 5. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s needs were assessed prior to admission a long time ago but the home had updated some of this information. People are not given clear information about the terms and conditions of their stay in the home and what they are expected to pay for, this could mean that people are at risk of exploitation. EVIDENCE: The home is registered for up to twelve people within two purpose-built houses and currently has one vacancy. None of the three files examined contained an up to date assessment completed by the local authority but the home had completed their own assessment in 2006 in all three of the care files. One of the care files also contained a recently updated care plan completed by the local authority. However the staff team appears to be stable, which means they know what most of the peoples needs are, and are able to meet them. Fraser Drive DS0000002959.V366821.R01.S.doc Version 5.2 Page 10 The home has statement of purpose and service user guide and all of the people had a statement of terms of conditions. We were told that people are expected to pay for carpets, decorating and some furniture in their rooms, this is not explicit within any of the documents examined, in fact the statement of terms and conditions stated “you may wish to decorate and furnish you room” but no detail of who is expected to pay for this. In addition to this we were told that the people living in the home are expected to pay for themselves and the cost of staff when they go on holiday, the company pays the staff wages and expenses, again this was not explicit within any documents examined and there was no evidence that anyone had been consulted about this practice on behalf of the people living in the home. All of these documents must be updated and give correct and unambiguous information for the people living in the home. The placing local authority, relatives and/or advocates must be consulted about what the people living in the home are expected to pay for and this needs to be clearly detailed in the statement of purpose/ service users guide and contracts. Fraser Drive DS0000002959.V366821.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s needs were generally well planned for and the documentation gave good guidance to care staff. The home enabled people to actively take part in decision-making and taking risk was seen as part of their choice in how they wish to live their lives. EVIDENCE: Three care files were examined as part of this site visit. All contained updated assessments completed by staff on which to formulate the plans of care. Staff had completed ‘this is my life’ documentation with people and in some cases with their relatives. It was presented in a person-centred way and detailed the persons’ likes, dislikes and preferences. Some files also had detailed ways in which people communicated their needs in verbal and non-verbal means. The assessment information assisted staff members to formulate plans of care. Fraser Drive DS0000002959.V366821.R01.S.doc Version 5.2 Page 12 The care plans were written as routines that guided staff members in how the person preferred to be supported throughout their morning, afternoon, evening and night time routines. The care plans described individual care needs and likes and dislikes, for example how the person communicated, how they were supported with personal hygiene and what they were able to do for themselves, what they liked to have for breakfast or how they liked to spend their day. They covered a wide range of needs and included health action plans. There was evidence that they were kept under review, although these were overdue, therefore the requirement previously made for reviews to take place on a six monthly basis remains outstanding. Staff members had signed to state they had read the care plans and those spoken with were aware of how to meet peoples’ needs and enable them to maintain independent living skills. None of the staff have received training or briefings in the mental capacity act therefore they were not aware of their responsibilities in relation to decision making for people who lack capacity. The manager was due to attend the training in July 2008 and will be able to cascade this to staff. Through discussions with people that live in the home and staff members, through observation and from reading the care plans it was evident that people were encouraged to make decisions about their lives. One person confirmed they could make some choices about their daily life, for example he had chosen the colour of his bedroom and liked to choose what he has for his packed lunch each day. Risk assessments were in place for a range of situations, which aided the decision-making processes. The staff said that people were encouraged to develop independent living skills including light cleaning and washing their laundry within their capabilities, ‘we give people the chance to live the life they want’. The manager confirmed that people living in the home were consulted when new staff members were interviewed. Potential staff members spend a few hours or a day at the home and people are asked their opinion about them. Seven of the eight surveys received from people and that lived in the home had ticked the boxes stating they can choose what they want to do during the day, at night and at the weekends. Staff had assisted them to complete the surveys. Four surveys were received from relatives and all four stated the home provided the care and support as agreed. Fraser Drive DS0000002959.V366821.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People continue to be part of the local community taking advantage of local facilities and maintaining relationships with family and friends. The dynamics of the home means that some people are not living safely with people they want to live with. The home provides a well balanced diet thereby meeting the nutritional needs of people, whilst offering choice and alternatives. EVIDENCE: All three care files examined during the site visit contained activity plans, although some of these needed updating as some activities and facilities detailed no longer applied. Activity plans covered a range of interests and Fraser Drive DS0000002959.V366821.R01.S.doc Version 5.2 Page 14 outings such as, local authority day centres, gardening groups, access to a snoozelum (sensory equipment), car rides into the countryside, train ride to Doncaster, shopping at Meadowhall, trips to the coast, swimming, bowling, pub meals and visits to a local farm. One person had also spent an enjoyable day at the company’s main office shredding paper. In discussions one person told us they liked living at the home and had computer lessons during the week. He had regular contact with his family visiting them on some occasions and they visit him at his home on others. He explained how he liked to go shopping to local supermarkets and enjoyed gardening at his home and as part of the gardening club visiting the other homes in the company. Staff told us they arranged coffee mornings with other homes in the company and people had made some friends in this way. They also stated that an outreach team visited the home fortnightly and supported about six people each time for outings and picnics etc. People in the home contributed £11 a week to the cost of a car for their use. This had been agreed with them and their relatives. The manager confirmed that even if people didn’t use the car during the week it was used for them at weekends so each person benefited from it. The home also funded the use of a second car. Staff stated that they had completed training in cultural awareness and tried to ensure that people’s diverse needs were met. For example one person was of Caribbean lineage and their family supported them to attend functions. Staff had also organised theme nights on a monthly basis with culturally diverse foods such as, Italian, Irish and Caribbean. One staff member accompanied some people on a regular basis to a ‘faith and light’ club at a local church. We were told that holidays had been arranged for people last year and similar holidays were being planned for this year. In addition to this we were told that the people living in the home are expected to pay for themselves and the cost of staff when they go on holiday. The company pays the staff wages and expenses. This was not explicit within any documents examined and there was no evidence that anyone had been consulted about this practice on behalf of the people living in the home. There was a friendly and relaxed atmosphere in the houses during the visit and staff members were observed talking to people in a caring way. There were incidents recorded between people that live in the home and also unexplained bruising noticed by staff. The manager confirmed they were aware of the issues and that some people did not get on with each other. They had spoken to the local authority about addressing the home dynamics. Some people had been in the home a long time and did not have a choice in the beginning about whom they shared their home with. A process at looking at this issue had started. Fraser Drive DS0000002959.V366821.R01.S.doc Version 5.2 Page 15 Staff members prepared meals and the menus seen were planned but were subject to change if people preferred alternatives. The main meal was in the evening as some people were out during the day. Lunch tended to be a snack of sandwiches or something on toast. Menus reflected that staff tried to promote a healthy eating menu and balanced this with people’s likes/dislikes and special treats on occasions. Fraser Drive DS0000002959.V366821.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 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The personal care needs of service users are documented and met by the service and staff. The emotional needs and in some cases health needs of some people are compromised by ongoing incidents between people that live in the home. Generally medication was well managed but the system of people attending day centres and leaving medication unattended in their bag could place people at risk. EVIDENCE: In the three care files examined staff had completed health action plans for each service user that detailed areas of health that required support and intervention. There was evidence of input from GP’s, community nurses, dentists, dental hygienists, opticians and chiropodists. Various monitoring charts were used when it was identified service users had particular risk areas, for example, epilepsy. Fraser Drive DS0000002959.V366821.R01.S.doc Version 5.2 Page 17 The GP had visited one person when staff noticed, ‘severe bruising’ on him. There had been other occasions when bruising had been recorded but staff did not know the cause. There had been recorded incidents between people that lived at the home, which affected their health and emotional wellbeing. Care plans detailed how privacy and dignity was to be promoted and staff members spoken with described ways in practice that this occurred, ‘we have things that are non-negotiable, like knocking on doors, respecting privacy, showing people we care and asking people what they want not telling them’. Staff explained that a group of residents and staff in the company determined these ‘non negotiable’ good practice items and they were initiated in the homes to be used by all staff. A framed list was on display in the home. Comments from relatives were, ‘I would like to see more care taken with the laundry, as he often wears odd socks and I am continually replacing them as they go missing’ and ‘they are very concerned about his welfare and organise doctor visits if necessary’. One relative stated in a survey, ‘young care staff allowed him to have food on demand’ which had apparently resulted in a weight problem for the person. They also stated that the manager appears to have sorted this out now. The medication systems were examined at this visit and appeared to be generally satisfactory although there were a few missed signatures with no codes to explain why. There was also no evidence that some prescribed creams were administered. When staff transcribed medication onto the medication administration record they did not consistently have two signatures as required. It was also noted that some people attended a day service and took with them in a separate container, their medication for the lunchtime dose. The medication was not handed over to receiving staff but maintained in their bag until required when it would then be handed over to staff to administer. As bags are left unattended during this time this could place people at risk. We were told that staff members who administer medication have completed a training course with the local pharmacy regarding the system they provide to the home. The training course needs to be an accredited course that gives staff a wide breadth of information about medication management. Fraser Drive DS0000002959.V366821.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 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides an environment where people feel able to complain. Incidents have occurred between residents, which have caused them harm and distress. Staff members have received training in how to protect vulnerable people from abuse but safeguarding policies and procedures have not been followed. EVIDENCE: The home has a complaints policy and procedure that is found within the statement of purpose and service user guide. It is available in a simplified version. The policy and procedure needs updating to include the contact details of the local authority as commissioners of the service. The complaint form itself should contain space for complainant satisfaction with the outcome. The procedure also needs to be on display within the home. The AQAA documentation states that the home has not received any complaints in the last twelve months. The Commission has also not received any concerns or complaints. Most surveys received from people detailed they would be happy to speak to staff about any issues that were concerning them and some named individual staff members as the people they would go to if they were unhappy. This was Fraser Drive DS0000002959.V366821.R01.S.doc Version 5.2 Page 19 also confirmed in a discussion with a specific resident. Relatives were aware of how to complaint and staff in discussions and surveys also demonstrated they knew what to do, and how to record it, if someone complained to them. Staff members spoken with during the day displayed an understanding of the different types of abuse but they did not appear knowledgeable about third party investigation, stating, ‘the manager would investigate’. We noticed several incidents either recorded in an, ‘incidents’ file or the accident book relating to issues between residents. These ranged from assaults such as people being kicked, hit, pushed and slapped to staff noticing bruising ranging in size and severity. These incidents were only logged by staff, and not referred to the safeguarding team in the local authority for consideration of what action to take. One incident did result in a GP visit. The manager confirmed in a discussion that she had had conversations with the local authority regarding some of the incidents but this had not been done in a safeguarding forum. The dynamics of the home is currently under review and the manager stated people are to be asked who they would like to share a home with and with how many people. The training records indicated that all but one person had received training in how to protect vulnerable adults from abuse. This training must be re-visited to ensure that all staff members are aware of their responsibilities in following multi-agency policies and procedures. The home has policies and procedures to cover adult protection and prevention of abuse, whistle blowing, aggression, physical intervention and restraint and management of people’s money and financial affairs. Fraser Drive DS0000002959.V366821.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 and 30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People live in a generally safe and comfortable environment suitable for their individual needs and lifestyles. EVIDENCE: Both houses were well maintained and provided a pleasant environment for people to live in and staff to work in. The houses were homely and nicely decorated. The houses had plenty of communal space and each person had a single bedroom. Staff had sufficient office space. When we arrived a resident answered the doorbell and let us in. Staff could not be located for about ten minutes and we had access to the home and the people that lived there. Three staff members, covering both homes, were eventually found in the garden. They did not hear the doorbell. This posed a clear risk and needs to be addressed. This is covered in standard 43 – health and safety. Fraser Drive DS0000002959.V366821.R01.S.doc Version 5.2 Page 21 Bedrooms were clean and personalised to meet peoples’ individual needs and taste. People spoken with were happy with their bedrooms and communal space provided. One person was happy to show us his bedroom and confirmed he had chosen the colour scheme, bed linen and curtains himself. He said, ‘I like living here, I have my own TV’. The garden spans both houses at the rear of the property, is secure and is very well maintained. There is a greenhouse and staff confirmed one particular resident is keen on gardening and enjoyed taking part in gardening activities. Seating is provided and the garden is an attractive, safe and accessible area for people to use in the warmer weather. Staff members were responsible for the general cleaning of the home. He home was clean and fresh and staff obviously worked hard to maintain the standard. Fraser Drive DS0000002959.V366821.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has good recruitment and induction systems in place. This means that relevant parties are assured only appropriate people work with vulnerable adults. Some gaps in training means that not all staff will have the required skills to support people fully. EVIDENCE: The rota evidenced that there are two support workers in each house allocated per shift during the day and one waking night staff in each house. Staff spoken with generally felt they had enough on duty to support the needs of people. The manager was supernumerary. One person spoken with told us that staff let him do as he pleases and that they looked after him well. In surveys relatives stated that staff always kept them informed of important issues and helped their loved ones keep in touch with them. Fraser Drive DS0000002959.V366821.R01.S.doc Version 5.2 Page 23 The company ensured that new staff members completed an induction, which included in-house procedures and progression through the learning disability award framework (LDAF) induction. This covered common induction standards in separate modules and ensured that competency was assessed throughout the process. The training log included the required mandatory and service specific training such as cultural awareness, epilepsy, diversity, mental health needs and person centred planning. Not all staff had completed training in how to manage behaviours that could be challenging, nor mental capacity legislation. Medication training needs to be accredited and staff need to re-visit safeguarding to ensure they can identify abuse and know what to do and who to refer issues to. The manager confirmed that the home was progressing through an ‘Autism Accreditation Programme’ and records examined did confirm that staff had completed training in Autism in April 2008. Surveys received from staff members indicated they received training that was relevant to their role, equipped them to meet individual needs and kept them up-to-date. Those spoken with confirmed that they had undertaken training and they were confident they could meet peoples’ needs. According to information received from the manager five out of twenty, care support workers had completed national vocational qualifications (NVQ) in care at level 2 and 3. This equated to 25 of care staff trained to this level. A further four care support staff were progressing through the training and three people were registered and ready to start the course. The home needs to aim for 50 , however the manager confirmed last year they had exceeded the target but staff changes had affected the percentage. Staff members received regular supervision and appraisals. The recruitment process was discussed with the manager after the visit, as staff files were held centrally. She described a robust procedure of staff completing application forms, short-listing, interviews, and obtaining references and criminal record bureau checks prior to the start of employment. In surveys staff confirmed they had criminal record bureau checks prior to starting work. The manager also advised that people that lived in the home were consulted about any potential new staff and had the opportunity to meet them during the recruitment stage. The involvement of residents in the recruitment process was innovative and good practice. Fraser Drive DS0000002959.V366821.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Some gaps in the management of health and safety within the home need review to enhance the wellbeing of service users. EVIDENCE: The manager of the home is registered with the Commission and is progressing through the Registered Managers Award. She had completed relevant training appropriate to her role and has many years experience in supporting people with learning disabilities. Staff members spoken with and surveys received from them indicated the manager was fair, had a good approach and met with staff regularly. Fraser Drive DS0000002959.V366821.R01.S.doc Version 5.2 Page 25 Some residents knew the managers name and she was the first name mentioned when we asked people whom they would tell if they were unhappy about something. This showed us that the manager was well known to residents and they felt able to approach her with any problems. The home had a quality assurance system that included regular audits, for example medication, residents’ finances, and health and safety, which was last completed by a visiting manager on 28th May 2008. Some surveys were seen that had been completed by residents but there was no date and staff were unsure if these had been completed this year. The manager confirmed that questionnaires to residents were not completed in the year 2007-2008 as planned but they were to be completed this year to ensure residents’ views were obtained about how the service is managed. She also stated that the company had an, ‘are you getting a good service’ survey that was completed annually by an external person. Any shortfalls identified were actioned. The quality assurance system should include the views of relatives, staff members, care management and other health professional visitors to the service such as doctors and community nurses. Generally the building was a safe, homely and comfortable place to live with the majority of maintenance and servicing up to date and risk assessments were in place. However there were some areas to address: •When we visited, a resident opened the door on hearing the bell and we entered one of the houses in search of staff. We were able to walk around for approximately ten minutes and eventually found staff having a break in the garden. They had not been able to hear the bell. This obviously posed a risk to vulnerable people living in the home and their property. •In 9 Frazer Drive, a check of the emergency lights on 11.6.08 and again on 17.6.08 reported that the light at the bottom of the stairs was not working. There was no evidence recorded that it had been addressed. •The water temperatures recorded in bathrooms, bedrooms and one shower room sink were low, ranging between 23°C and 41.5°C. This should be at an ambient temperature of approximately 43°C. Conversely the sink in the activity room was 45.5°C but had been recorded as hot as 63°C, which could pose a risk of scalds. •The laundry areas in both houses had sinks with water temperatures of 65°C, which was a necessity, however both areas need to be inaccessible when not occupied by staff. There also needs to be a hot water sign for staff. •The Commission had not been notified of the incidents between residents. These affected their welfare and we would have advised a safeguarding referral to the local authority had we known about them. Fraser Drive DS0000002959.V366821.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 4 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 2 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 X 2 X X 2 X Fraser Drive DS0000002959.V366821.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA1 Regulation 4 and 5 Requirement Timescale for action 30/09/08 2 YA5 5 3 YA6 15 4 YA15 12(3) The registered person must amend and update the statement of purpose and service user guide so that people have up to date information and know what they can expect from the home. The registered person must 30/09/08 ensure that contracts/statement of purpose clearly identifies what people are expected to pay for and the placing local authority relatives/advocates must be consulted on behalf of the people so that they are not at risk of exploitation. As a minimum the care plans 30/09/08 must be reviewed every six months. (Requirement first made on 27/04/05 and a further requirement timescale was 01/07/06) The registered person must 30/09/08 ensure that residents are consulted about whom they wish to live with and plans made to address any issues DS0000002959.V366821.R01.S.doc Version 5.2 Page 28 Fraser Drive 5 YA19 12(1)(a) and 13(4) that arise from the consultation. The registered person must ensure that the emotional and health care needs of people living in the home are met with regards to their compatibility with each other and injuries they have received during incidents between people. 30/09/08 6 YA20 13(2) It is acknowledged that the compatibility issue has started to be looked at but must be completed quickly for the safety of some residents. The registered person must 31/07/08 ensure that when handwriting medication onto the medication administration record, this is witnessed and signed by two staff members. There must be evidence that prescribed creams are applied. 7 YA23 8 YA35 Care must be taken to ensure medication is signed for on administration or codes used to indicate why it has been omitted. 12(1)(a)&13(6) The registered person must 31/07/08 ensure that all levels of staff are aware of and put into practice the referral systems regarding safeguarding adults from abuse. This will ensure the local authority are fully aware of incidents between residents and can monitor and address them. 18 The registered person must 31/12/08 ensure that staff have the skills and competence to meet the specialist needs of DS0000002959.V366821.R01.S.doc Version 5.2 Page 29 Fraser Drive 9 YA39 24 10 YA42 13(4) the people that live in the home in areas of for example, mental capacity legislation, safeguarding adults, accredited medication and managing behaviours that can be challenging. The registered person should 31/10/08 ensure that the quality assurance process is fully implemented within the home and that stakeholders, professionals and the people that live in the home (or their representatives) are consulted about the running of the home. The registered person must 08/08/08 ensure that the health and safety issues mentioned in the text of the report are addressed: •Security of the building. •Hot water temperatures. •Accessibility of the laundry areas when unoccupied by staff. •Specific emergency lights not working in one of the homes. •Lack of notifications to the Commission. Fraser Drive DS0000002959.V366821.R01.S.doc Version 5.2 Page 30 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 YA20 Good Practice Recommendations The home should review the system of placing medication in residents bags when they attend day services as this, according to staff could be left unattended until its use at lunch time. The registered person should ensure that 50 of all care staff (including agency staff) achieves a National Vocational Qualification (NVQ) level 2 in care as a minimum. The registered manager should continue to work towards the Registered Manager Award. 2 YA32 3 YA37 Fraser Drive DS0000002959.V366821.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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. 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