Inspection on 13/03/08 for Fryers House

This inspection was carried out on 13th March 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Fryers House 10/03/09

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

CARE HOME ADULTS 18-65 Fryers House Fryers Close Botley Road Romsey Hampshire SO51 5TA Lead Inspector Christine Walsh Unannounced Inspection 13 March 2008 10:00 th Fryers House DS0000070855.V359336.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 Fryers House DS0000070855.V359336.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. Fryers House DS0000070855.V359336.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fryers House Address Fryers Close Botley Road Romsey Hampshire SO51 5TA 01794 526200 01794 515443 bernardboyle@lcdisability.org www.leonard-cheshire.org.uk Leonard Cheshire Disability 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) Miss Victoria Louise Edmunds Care Home 20 Category(ies) of Physical disability (0) registration, with number of places Fryers House DS0000070855.V359336.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Physical disability (PD). The maximum number of service users to be accommodated is 20. Date of last inspection Brief Description of the Service: Fryers House is a purpose built home for up to twenty service users with physical disabilities and nursing needs. It was developed to reprovide a service for people living in an existing service that was considered not fit for purpose. Fryers House is owned by Leonard Cheshire, a charitable organisation operating throughout the country and providing a range of services for people in need of care and support. The home is located on the immediate outskirts of Romsey, Hampshire, where the local town centre is easily accessible and the Cities of Southampton and Winchester can be accessed by local transport. Fees are £1,450 per week and one to one costs are costed separately. Fees do not include hairdressing and chiropody. Fryers House DS0000070855.V359336.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 the people who use this service experience adequate quality outcomes. This site visit formed part of the key inspection process and was carried over one day by Mrs C Walsh, Regulatory Inspector. This was the first visit to the home since registering with the Commission for Social Care Inspection. Mrs V Edmunds, the Registered Manager assisted on the day of the inspection visit. The manager completed an Annual Quality Assurance Assessment (AQAA) document, which was returned to the Commission for Social Care Inspection prior to visiting to the home and helped in gathering evidence to write this report. The AQAA told us that it considers the diverse needs of the residents by ensuring they are provided with information about social, political and cultural activities in the community and supported to access them. They are supported with their communication needs and the home develops the skills of the staff in order to meet these needs. The AQAA went onto tell us that people who use and work at the home have an understanding of the rights and responsibilities and respect for individual freedom. The information gathered to write this report was based on viewing the records of the people who use and work at the service, speaking with the residents, visitors and staff and observing care and support practices. A tour of the home took place and documents relating to health and safety were viewed. This was the first visit to the home since it registered with the Commission for Social Care Inspection in September 2007. What the service does well: The home assesses if it can meet the needs of people who wish to use the service prior to them moving in and supports them to become familiar with their new surroundings and others living in the home. The home supports the residents using a person centred approach, respecting their wishes, decisions and aspirations. Care plans and risk assessments are Fryers House DS0000070855.V359336.R01.S.doc Version 5.2 Page 6 individualised and provide clear information on how the residents wish to be cared for and supported. It encourages the residents to develop and maintain their independence, integrate into their local community and maintain contact with family and friends. The staff ensure the physical and psychological needs of the residents are being met, providing the residents with support to access health care professionals such as GP’s, dentists, nutritionists and speech and language therapist. The home listens to the resident’s needs, wishes and concerns and acts promptly to deal with any concerns or complaints the residents or their representatives may have. The staff are trained to protect the residents and to inform someone immediately if they are concerned that they are at risk of harm. Fryers House is a purpose built home which is separated into two units. It offers a homely, safe and welcoming environment, which is spacious, tastefully decorated, furnished and designed to meet the physical needs of the residents. Individual bedrooms are personalised and decorated to the residents liking. The manager and staff are skilled to meet the needs of the residents, they go through an interview and induction process followed by mandatory training such as moving and handling and fire safety, and specific training such as abuse awareness, epilepsy, diabetes and Multiple Sclerosis (MS). What has improved since the last inspection? What they could do better: Two requirements and two recommendations have been made on this occasion. The home must ensure that it is following correct procedures on checking fire safety equipment, such as fire alarms and ensure this is in line with Fire Safety Legislation. The home must ensure that the residents receive their medication at all times as prescribed, to ensure their physical health is not compromised or put at risk. Although the home provides evidence that it deals with concerns and complaints appropriately, it is recommended that all residents’ relatives or representatives are provided with a copy of the home’s complaints procedure. Fryers House DS0000070855.V359336.R01.S.doc Version 5.2 Page 7 The home ensures it’s staff receive appropriate training to undertake their roles and responsibilities, but it is recommended that at least 50 of care staff should have a National Vocational Qualification (NVQ) in care to level 2 or above. 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. Fryers House DS0000070855.V359336.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 Fryers House DS0000070855.V359336.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home ensures the people who wish to move into the home have their needs assessed prior to admission to ensure it can meet their needs. EVIDENCE: The AQAA (Annual Quality Assurance Assessment) informed us that, “the home undertakes a pre admission assessment and encourages prospective service users to visit the home to see if it suits their needs before moving in”. Although it recognises it could do better to “develop a welcome booklet guide for prospective residents and their families”. This was tested by viewing the assessment documents of four residents, speaking with two residents, the manager, a member of staff, and a relative. The pre assessment documents seen for four residents provided detail of their assessed and current needs, including personal, cultural, social, physical, specific nursing needs and mental health needs. The manager spoke of the assessment process, which includes meeting with the prospective resident, relatives and existing staff. Care management and health care professional’s assessments are obtained where required. Fryers House DS0000070855.V359336.R01.S.doc Version 5.2 Page 10 There is evidence that on admission further assessments and checks are undertaken such as health care observations, checking residents’ skin integrity (Waterlow assessment) and an assessment that measures residents’ independency levels (Bartel assessment). A resident said: “The manager visited me before I moved in and asked lots of questions about my needs and she provided me with information about the home”. Another resident who moved into the home for respite care has decided to permanently move into the home, as she likes it so much. The manager stated that following a trial period of four weeks a review takes place with the resident, their relatives and representatives, to establish if the home is successfully meeting the resident’s needs, and if the resident is happy to remain in the home. Fryers House DS0000070855.V359336.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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home ensures the people who use the service have their needs met using a person centred approach and are supported to have a say about how they wish to receive their care and make decisions about their everyday lives. Risks to the health and welfare of the people who use the service are minimised by using a risk management approach. This involves assessing the level of any risks, and recording measures which can be taken to reduce those risks, wherever possible. EVIDENCE: The AQAA (Annual Quality Assurance Assessment) informed us that, “the home has adopted a team and keyworker system to review paper work to ensure that all service users have detailed and informative individual service plans to reflect the care and support required and to instruct and guide staff, this includes risk assessments”. Although the home recognises it could do better, Fryers House DS0000070855.V359336.R01.S.doc Version 5.2 Page 12 “to develop information in alternative formats to assist people who are visually impaired or have difficulty understanding the written word”. This was tested by viewing personal plans, including risk assessments and daily notes of four residents, two of whom are new to the service. We spoke with two residents, a member of staff and a visiting relative. Each resident has a personal plan of their own which provides information on social interaction, health and keeping safe, personal care, communication, behaviours, independence and daily notes. Care plans are written as if the resident has written them and provides detail on how the resident needs assistance which allows for consistency of care. The home recognises the rights of the residents to request who they would like to support them with their personal care, including the gender of the member of staff and this is recorded in personal plans. This demonstrates the home recognises and respects the resident’s rights. Care plans are linked to risk assessments, which provides detail of any risks and the action needed by staff to minimise the risks. The information is written in plain English and easy to follow. A resident informed us she is aware she has a personal file and knows she can have access to it if she wishes. There was evidence that care plans and risk assessments are regularly reviewed and where possible the resident has provided input and signed to show their agreement. A relative was complimentary of the care and support her daughter receives: “I can’t fault the staff, they do a very good job and look after my daughter very well” A resident said: “The staff look after me very well”. Another resident indicated using the thumbs up gesture that they are happy living at Fryers House. The manager stated that the home is still in the process of revising the documentation used to record residents personal needs and hopes soon to develop a person centred plan. This would consider residents’ dreams, aspirations and goals, making it real for them and supporting them to make future decisions about their lives. A pen picture for one resident was seen and provided information about the residents past history, hobbies and interests. The manager confirmed that the home is planning to do this for everyone, with the assistance of the residents, their family and friends. It was observed during the course of the visit that residents are encouraged to make decisions Fryers House DS0000070855.V359336.R01.S.doc Version 5.2 Page 13 about how they wish to spend their day, what activities they wish to engage in and making everyday choices such as what they would like to eat and drink. Fryers House DS0000070855.V359336.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): 12,13,15,16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home ensures the people who use the service are supported to maintain an active lifestyle that suits their needs and individual interests. The home ensures the people who use the service maintain contact with family and friends and socially engage with their peers and the local community. The home ensures the people who use the service have their rights respected, are provided with opportunities to make decisions and develop individual living skills. EVIDENCE: The AQAA (Annual Quality Assurance Assessment) informed us that, “the home has recently developed a system to support service users to take part in a range of activities and to be active members of their community. They are Fryers House DS0000070855.V359336.R01.S.doc Version 5.2 Page 15 offered a well balanced diet and we ensure that our service users really become part of the community and increase the number of external outings such as attending the theatre, shopping and bowling”. This was tested through observation on the day of the visit, speaking to residents, a visiting relative, staff and the manager. The manager spoke enthusiastically about the forthcoming plans to develop the homes internal and community based activities, demonstrating that she is aware of person centred planning and the importance of listening to the wishes and decisions made by the residents. The manager admits that this is in its early development, but that she has appointed a member of staff to take the lead on developing activities. They will meet with each resident to establish what their hobbies and interests are. She has asked all staff to assist in surveying the local community to view accessibility to amenities and transport. Personal plans detail the resident’s weekly activities, hobbies and interests. Plans for a resident to attend Goodwood races was confirmed by the resident who appeared excited about the forth coming event and plans to take some residents to the local theatre were in motion. Other activities include residents developing independent living skills such as cleaning, cooking, shopping and collecting their prescriptions from the doctors. The home has been designed to support residents to undertake independent living skills and this is work in progress. The home has an activities room, with access to a computer, arts and crafts and sensory equipment. The residents are supported to maintain contact with their family and friends, and on the day of the visit a relative was noted to be made welcome by staff. A relative said: “ I am always made to feel very welcome, the staff are very pleasant and always offer me a cup of tea”. The manager stated that the residents are supported to maintain contact with family and friends and assistance is provided for residents to send letters and make telephone calls. The home supports residents to have a say in their daily lives and decision making. This was observed on the day of the visit, with residents being encouraged to do things for themselves and make decisions about what they would like to do. Staff were observed interacting with residents in a respectful manner and supporting residents to make informed choices. Fryers House DS0000070855.V359336.R01.S.doc Version 5.2 Page 16 The home caters for a range of nutritional and dietary requirements such as people who have diabetes, people requiring specialist feeding equipment and supporting people with specific dietary preferences such as vegetarian. At the time of the visit, a specialist nurse was visiting the home to support a senior nurse in the change of one type of specialist feeding equipment to a newer version. The purpose of the specialist nurse’s input is to provide training for staff, and to liaise with other specialists such as dieticians and speech and language specialists. The specialist nurse praised the home for its efficiency and developing good links with her, which has assisted in a smooth transition to using the new feeding equipment. She said: “It has helped having a named contact and dedicated time to run through the equipment and ensure all staff, including agency staff, have been trained in the use of the new equipment”. During the pre assessment process residents are asked for their likes and dislikes, the support they require to eat their meals and dietary preferences. On admission residents are weighed and their skin type and condition (integrity) is assessed, to establish if the person is prone to developing pressure sores, or has difficulties managing their weight. A recent meeting held with residents demonstrates that the home considers the likes and dislikes of the residents. Residents are asked in advance what they would like to eat and about their preferred options, such as a full English breakfast on Saturdays and when to have the main meal of the day. The manager stated that the home is in the process of supporting some residents to plan, prepare and cook their own meals, using the fully equipped and purposely designed kitchens. Fryers House DS0000070855.V359336.R01.S.doc Version 5.2 Page 17 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 adequate. This judgement has been made using available evidence including a visit to this service. The home ensures the people who use the service receive the appropriate support with their personal care and health care, in the way in which they require. The people who use the service must receive their medication as prescribed to prevent potential risks to their health and welfare. EVIDENCE: The AQAA (Annual Quality Assurance Assessment) informed us that, “the home ensures the residents receive support in a way that they prefer; their healthcare needs are appropriate to their preference and promotes the residents independence, privacy and dignity”. This was tested by observation, viewing four residents’ personal plans, medication administration records, speaking with residents, relatives, staff, the manager and visiting health care professional. The personal plans provide detail on how the resident wishes to spend their day including what time they like to get up, go to bed and have a bath. Fryers House DS0000070855.V359336.R01.S.doc Version 5.2 Page 18 A member of staff said he was aware of residents’ individual support needs as the staff are encouraged to read the residents personal plans, and be involved as a keyworker to support the residents with their everyday needs. Staff are also involved in reviewing the plans with the resident. The four personal plans which were seen provided evidence that they are reviewed regularly, and that residents are involved in the review of their plans. The member of staff went on to demonstrate that he has an understanding of the values of caring for people and the importance of ensuring the ethnic and cultural needs of the residents are respected. The manager stated that the home has good links with primary care and specialist health care teams. Personal plans demonstrated that the health care needs of the residents are regularly monitored and reviewed. Personal plans provide information on the residents’ specific health care needs, what action is required and how staff must attend to these health care needs. A relative said: “The home always informs me if there are concerns about the health of my daughter, but I do wish they would provide more physiotherapy as she gets very stiff at times”. The manager stated that the home was seeking the support of a physiotherapist, to provide support and training for staff in passive movements to assist with residents’ mobility and dexterity. Another resident confirmed that she has on occasions seen the GP in the privacy of her own room. The manager spoke of the plan to work with the community matron in keeping residents out of hospital, and how they intend to manage the needs of residents which are linked to their illness, and will gradually increase, such as those associated with Multiple Sclerosis (MS). The home has systems in place for the administration of medication. The home uses a monitored dosage system, which is supplied by a well-known high street pharmacy. Medications are received, stored, and disposed of using systems as stipulated in the Royal Pharmaceutical Guidelines. It was noted that not all areas of giving medications are followed correctly and safely, such as residents not recieving the correct dosage of medications and staff not signing to indicate the medications have been given. Before the completion of this report and shortly after the visit had taken place, the Commission for Social Care Inspection was notified of another complaint in respect of poor practice in the administration of medication, which affected the wellbeing of the resident concerned. The manager stated that action had been Fryers House DS0000070855.V359336.R01.S.doc Version 5.2 Page 19 taken with the staff member concerned. The manager also stated that she and a number of staff are to attend advanced medication administration training in April 2008. Fryers House DS0000070855.V359336.R01.S.doc Version 5.2 Page 20 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 adequate. This judgement has been made using available evidence including a visit to this service. The home listens to and acts upon the concerns raised by the people who use the service. The home is taking steps to improve its delivery of care to ensure the people who use the service are safeguarded from potential risk of harm. EVIDENCE: The AQAA (Annual Quality Assurance Assessment) informed us that “the homes complaints procedure is accessible to service users, staff, and volunteers and staff receive training in Whistle-blowing, disability, equality and protection of vulnerable adults and children”. But it knows that it must produce a complaints procedure in an accessible format for residents who have difficulty reading the written word. This was tested by viewing the complaints procedure and logbook, staff training records, speaking with residents, staff, a visitor and the manager. During the six months the home has been open, there have been a number of complaints and safeguarding concerns about the care of some of the residents. The home can show that it has taken action to report concerns to the appropriate authorities, including the Commission for Social Care Inspection. The manager stated that concerns raised by residents, their relatives and health care professionals have been, or are in the process of being, dealt with Fryers House DS0000070855.V359336.R01.S.doc Version 5.2 Page 21 and action is being taken to ensure residents are safeguarded. A memo to staff was seen, which reinforced their roles and responsibilities in raising and reporting concerns. A record of complaints and safeguarding concerns is sent four times a year to the organisations head office so it can monitor the trends and nature of the concerns and complaints. A record of complaints is kept and includes what the concern is about, the date the complaint was received, how and when it was acknowledged and if the outcome of the compliant has been investigated as happening or not. A relative said she hadn’t received a complaints procedure, but: “I’ve no complaints and I am impressed with the standard and quality of care my daughter receives”. The manager is advised to consider reissuing all relatives with a copy of the homes complaints procedure. There is evidence that staff receive training during their induction to the home on abuse awareness and the manager said new staff do not work with residents until training is completed. A member of staff told us what they would do if they witnessed or suspected an act of abuse, which is in line with the home’s, and the local authorities, policies and procedures. Fryers House DS0000070855.V359336.R01.S.doc Version 5.2 Page 22 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, 25, 29 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 ensures the people who use the service live in a welcoming, comfortable, clean, environment that will support their physical health care needs. EVIDENCE: The AQAA (Annual Quality Assurance Assessment) informed us that, “the home provides a comfortable environment that accommodates the needs of the people living in it, which is clean, warm and hygienic”. The AQAA also tells us that it plans to utilise the outside space with the support of the residents over the next twelve months. This was tested by taking a tour of the building, speaking with residents and viewing documents such as maintenance and cleaning schedules. Fryers House DS0000070855.V359336.R01.S.doc Version 5.2 Page 23 The home is a newly purpose built service separated into two units for the varying the physical and health care needs of the residents. It is spacious and is decorated and furnished in keeping with the needs of the residents. The home has equipment placed throughout the home to meet the residents’ physical disabilities. Entrances provide level entry and many doors open automatically when floor sensors are activated. The bedrooms are equipped with overhead tracking hoists to assist residents in an out of bed and into the bath. Bathrooms are equipped with specialist baths and wet rooms are available for people who prefer showers. A resident spoken with at the time of the inspection visit said they liked the home and found it comfortable. Individual bedrooms have been decorated to the residents liking and are personalised to reflect the resident’s personality, hobbies and interests. The home is clean and follows recognised practices in making sure the home is hygienically clean. Staff files show that staff have received infection control training. The home has a housekeeping assistance who said she has recieved training in infection control, control of substances hazardous to health (COSHH) and health and safety. Although staff training records show that staff have recieved training in infection control the manager may wish to consider placing some staff on a refresher course as some staff first received this training a number of years ago. The home has equipment in place to minimise the risk of infection such as equipment for disposing of clinical waste, laundry facilities with cleaning products to eradicate infections such as MRSA and disposable clothing and hand gels for staff. Fryers House DS0000070855.V359336.R01.S.doc Version 5.2 Page 24 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, 33, 34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home ensures that the people who use the service are supported by adequate numbers of trained, and appropriately recruited staff. EVIDENCE: The AQAA (Annual Quality Assurance Assessment) informed us that “the home support the residents with a team of staff who are appropriately recruited and trained”. The manager recognises the home could do better to further recruit and stabilise a fulltime staff team ensuring they have all training they require. This was tested by observing practice, viewing staff recruitment and training records, speaking with staff and residents. The home was busy at the time of the visit as residents were undertaking various activities with staff support. This included supporting residents to go shopping, supporting them with their personal hygiene and dealing with issues relating to health care needs. The staff appeared organised and confident whilst carrying out these activities. Fryers House DS0000070855.V359336.R01.S.doc Version 5.2 Page 25 The home relies heavily on agency staff, as the home is currently short of permanent staff. The manager stated that the agency staff are well known to the service and the residents, and know the residents well enough to provide a continuity of care. The manager went on to say that the service is undertaking a recruitment drive and is hoping to fill staff vacancies soon. A relative commented that they were pleased with the standard of care provided by staff. Staff are encouraged by the company to undertake a National Vocational Qualification (NVQ) in care to level 2, 3 and 4, and currently 20 of the staff team have achieved a NVQ. The manager is aware that the National Minimum Standards for Care Homes for Adults recommend at least 50 of staff trained to this level, and stated that seven staff are waiting to start a NVQ. Plans are in place to support staff to undertake a NVQ in Therapy. The recruitment files of three newly appointed staff were seen and these were found to hold all the specified documents required when employing staff to work with vulnerable people. Evidence of an application form, two references, criminal record bureau (CRB) disclosure and protection of vulnerable adult (POVA) checks, were in place for each new member of staff. Staff receive training required by law (mandatory training), such as moving and handling, first aid, fire safety and food hygiene. In addition they receive training specific to the needs of the residents, such as care of medicines, epilepsy, managing challenging behaviour and Multiple Sclerosis. A newly appointed member of staff confirmed that she had received a thorough induction and is receiving support from other staff to ensure she is carrying out her roles and responsibilities correctly, she went onto say: “I am really enjoying my job, it’s a bit challenging at times but you get good support from the manager and staff, there’s good team work and things have really improved since the manager has returned”. Fryers House DS0000070855.V359336.R01.S.doc Version 5.2 Page 26 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is run by a manager and a staff team who are taking steps to ensure it is run in the best interest of the people who use it, but the management needs to be more robust, to fully safeguard people who use the service. Fire safety checks must be undertaken as required by fire safety legislation, to protect people who live and work at the service from potential risks to their safety. EVIDENCE: The AQAA (Annual Quality Assurance Assessment) informed us that “the home provides a well-run service where the residents are regularly consulted with and or their relatives as appropriate and the health, safety and welfare of residents is promoted and protected”. Fryers House DS0000070855.V359336.R01.S.doc Version 5.2 Page 27 This was tested by spending time with the manager, speaking with staff and residents, viewing health and safety documents, quality audits and observing management practices throughout the day. The manager demonstrated through the course of the day that she has an understanding of the needs of people who need nursing care, who have physical disabilities, and of her roles and responsibilities in ensuring their needs are met. This has ensured that there are a number of good outcomes for people who use the service, as assessed at this key inspection, but the outcomes in relation to the personal and healthcare support, and concerns and complaints outcome groups have been assessed as only adequate. This indicates that the home needs to be managed more robustly, to ensure the health, safety and welfare of residents. Two members of staff spoken with at the time of the visit both said they found the manager approachable, supportive and she treats the residents with courtesy and respect. This was also confirmed by a relative who said she felt the manager was good at what she does and is understanding of both her and her daughters needs. The home intends to carry out a quality audit of the service yearly to seek the views of the residents and relatives. The home holds monthly resident and staff meetings, and the home is visited once a month by a senior manager in the company who carries out an unannounced monitoring visit to the home, as required by Regulation 26 of The Care Homes Regulations. This provides the manager and staff team with guidance as to how they can continue to improve the quality of care and support. Regulation 26 requires organisations which are not in day to day control of the home, to appoint a person to make monthly, unannounced visits to the home. The visitor should speak to residents, check specified records and look at the premises. They must write a short report of the findings and a copy of the report must be provided to the manager. Residents are supported with their finances, and their care plans provide information on how much support each resident requires. The home has systems in place for managing and recording resident’s spending, in order to safeguard them from financial abuse. There are systems in place for fire safety, and staff receive regular training. Regular checks are made on fire safety equipment, but it is recommended that the Fire Safety service is contacted, to find out how often checks on fire alarms must be carried out, as currently they are being done on a monthly basis. Products which may be harmful were securely locked away, as required by the Control Of Substances Hazardous to Health (COSHH) regulations. There are notices discreetly displayed around the home reminding people of good Fryers House DS0000070855.V359336.R01.S.doc Version 5.2 Page 28 hygiene practices. All serviceable utilities, including small electrical appliances are regularly checked to ensure they are in good working order. Fryers House DS0000070855.V359336.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 X 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 2 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 X 2 X 3 X X 2 X Fryers House DS0000070855.V359336.R01.S.doc Version 5.2 Page 30 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 YA20 Regulation 13(2) Requirement Arrangements must be made for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home, to ensure the people who use the service receive their medication as prescribed, and will not have their health care needs compromised or put at risk. The home must be conducted so as to promote and make proper provision for the health and welfare of people who use the service. Timescale for action 27/03/08 2 YA37 12 (1) (a) 27/03/08 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 YA22 Good Practice Recommendations It is recommended that the home’s complaints procedure is provided to relatives and representatives of the people DS0000070855.V359336.R01.S.doc Version 5.2 Page 31 Fryers House 2 3 YA32 YA42 using the service. It is recommended that the service ensures 50 of its staff have, or are working towards a National Vocational Qualification. It is recommended that advice is sought from the fire service as to the required frequency of testing the fire alarm system. Fryers House DS0000070855.V359336.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Maidstone 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. 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