Inspection on 11/04/07 for Gallaudet Unit

This inspection was carried out on 11th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Gallaudet Unit 16/11/06

Gallaudet Unit 14/06/06

Gallaudet Unit 06/02/06

Gallaudet Unit 02/08/05

Gallaudet Unit 14/03/05

Gallaudet Unit 06/09/04

Gallaudet Unit 06/01/04

Similar services:

5 Seafield Road

Honeybourne House

Longrun House

Bodley Community Care Support Centre

Thomas Pocklington Trust

Chantry Gardens

Penkelly House

25-27a Alexandra Road

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

CARE HOME ADULTS 18-65 Gallaudet Unit RNID Poolemead Centre Watery Lane Twerton Bath Bath & N E Somerset BA2 1RN Lead Inspector David Smith Key Unannounced Inspection 11 , 12 and 20th April 2007 10:00 th th Gallaudet Unit DS0000040658.V334870.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 Gallaudet Unit DS0000040658.V334870.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. Gallaudet Unit DS0000040658.V334870.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gallaudet Unit Address 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) RNID Poolemead Centre Watery Lane Twerton Bath Bath & N E Somerset BA2 1RN 01225 356487 01225 480825 ruth.young@rnid.org.uk RNID Mrs Ruth J Young Care Home 8 Category(ies) of Sensory impairment (8) registration, with number of places Gallaudet Unit DS0000040658.V334870.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 8 persons aged 18 to 64, requiring personal care. 16th November 2006 Date of last inspection Brief Description of the Service: Gallaudet offers single rooms to accommodate deaf people with special needs, including those with moderate physical disability. The environment is a single storey building, which is part of a large complex incorporating other units, surrounded by attractive gardens and grounds. The home, one of the services operating as part of the Royal National Institute for the Deaf (RNID), has its own clearly defined philosophy of care, which aims to embrace varying levels of independence and autonomy where each person is encouraged to achieve their full potential as adult members of the wider community. The current fees range from £1100.00 to £2200.00 per week, depending on the particular support needs of service users. Gallaudet Unit DS0000040658.V334870.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced visit as part of a Key Inspection of this service. I gathered information through discussions with service users, the Registered Manager, Deputy Manager, Senior Support Workers and Support Workers. Interaction and communication between staff and service users was also observed during the course of my visit. Care plans and associated records were examined together with medication administration, Risk Assessments, accident/incident reports, complaints log, staffing and health and safety records. I was also provided with a tour of the home. Other sources of evidence have been used as part of the Key Inspection process. These include the home’s action plan in response to the last CSCI inspection and ensuing enforcement notice; the providers own monthly auditing of the service and notifications of significant events which have occurred within the home. The Commission also provided the home with a Pre-inspection Questionnaire, Service User Survey Forms and a range of Comment Cards for stakeholders prior to this visit. The Pre-inspection Questionnaire was completed and returned together with two Service Users Surveys. Seven other Comment Cards were also returned. This inspection was concluded with a separate meeting with the Registered Manager, Deputy Manager, Residential Services Manager, CSCI Regulation Manager and myself on the 20th April 2007. What the service does well: Each service user who responded by survey said they were always treated well by the staff and chose what they wanted to do each day. Relatives who responded by comment card said the home gave their relative the care and support they expected. The staff team remain committed in providing support to each service user to enable them to lead fulfilling lives. Service users and staff interact well. Staff use specialist communication skills to support this process. Gallaudet Unit DS0000040658.V334870.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Gallaudet Unit DS0000040658.V334870.R01.S.doc Version 5.2 Page 7 The improvements in the care planning and review process must be completed for each service user. This will ensure consistent approaches in supporting each person, which are regularly reviewed. The staff training in the Protection of Vulnerable Adults, Challenging Behaviour and other core/relevant specialist training must be completed by each member of the team. This remains crucial in ensuring the safety and welfare of service users and in providing appropriate and consistent levels of support. Additional training sessions have been planned to ensure all staff members complete all necessary mandatory and specialist training. All staff must attend all planned sessions, and the CSCI has been given assurances they will. The enforcement notice issued in relation to the training of staff will therefore be signed off by the CSCI as being complied with. The improvement of the Risk Assessment processes must be completed. This will ensure safe working practices are present within the home to promote the welfare of service users and staff. Fire safety within the home must be improved. This will help to ensure the welfare and safety of services users and staff. The progress in providing service users with information in a format which is accessible to them should be reviewed. The home should conduct another quality assurance review. This will ensure the quality of the service provided is accurately measured. 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. Gallaudet Unit DS0000040658.V334870.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 Gallaudet Unit DS0000040658.V334870.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 and 5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home fails to provide people who live in the home a statement of terms and conditions and to ensure that information for prospective service users is in an accessible format. EVIDENCE: The Statement of Purpose is detailed and it is noted that this will be updated every six months. It is still anticipated that this document will be made available in an accessible format. However, this currently is not in any other format other than written English. Each service user who responded by survey said that they were asked if they wanted to move into the home and had enough information to help them decide if Gallaudet was the right home for them. The home does not have copies of any contracts from relevant Funding Authorities. Although the Statement of Purpose contains a template for a Licence Agreement for each service user, there is no evidence of these being in place for all of the individuals who live in the home. Gallaudet Unit DS0000040658.V334870.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is making efforts to ensure that the service provided to those that live in the home takes into account personal preferences and is supported by written information in care plans and risk assessments that are subject to ongoing review and updating including making them available in accessible formats, where possible. EVIDENCE: The home has now reviewed and improved the care planning process and format. I examined three service users care plans in detail. Each service user has an “Evidence Folder” and “Daily Records” files. The Evidence Folders, where the main care planning records are stored, have been significantly improved since my last visit to the home. Gallaudet Unit DS0000040658.V334870.R01.S.doc Version 5.2 Page 11 These are now clearly divided into three sections; ‘Information’, ‘Working Documents’ and ‘Recording of Evidence’. Each file contains both a full needs assessment plus a Care Plan which describes how each person’s support needs are to be met. This covers relevant areas of support such as daily living skills, home skills, communication, family contact, education and money. The ‘Daily Records’ provide a summary of each service user’s day. It is apparent that the home now has a consistent and effective structure for care planning, which can be used as a basis for continued improvement and development of this area. There have been a number of annual review meetings. These have been attended by the service user, staff members, family members and a representative of the relevant Funding Authority. Each meeting has been recorded and these records clearly explain the discussions and the outcomes. Each service user now has named ‘Keyworkers’. Part of their role will be to ensure that care plans are reviewed at least every three months or sooner if a person’s needs change. The home is supporting this process by rostering each member of staff on a regular ‘Keywork’ shift, where they can spend time on administration duties. ‘Care Team Meetings’ involving the service users and their Keyworkers, have also been re-introduced. These are designed to ensure all care plans are regularly reviewed and updated with the involvement of the service user wherever possible. These meetings have only been re-introduced this month, for two service users, although all other meetings are planned. It is therefore not possible to assess the effectiveness of this process in reviewing and updating care plans between annual reviews. However, this will be examined in detail during the next inspection process. During the course of my visit I observed interaction, communication and support between the staff team and service users. This demonstrated staff have a good knowledge of service users support needs and how to communicate effectively with them. Various forms of communication continue to be used to enable service users to make choices. I observed British Sign Language, clear speech and some written/drawn communication being used. There are also pictures/picture symbols in use and some information has been adapted into the ‘Writing with Symbols’ format (which is known as ‘Widget’). There are person-centred Risk Assessments in place for some service users, which support them to take risks as part of their lifestyle. However, these still remain limited in their number and scope. Gallaudet Unit DS0000040658.V334870.R01.S.doc Version 5.2 Page 12 The home is currently being supported by the RNID’s Risk Manager in this area. They are providing Risk Assessment training to staff, general guidance and information, have introduced a more effective assessment tool for staff to use and are reviewing each new assessment as it is completed. Both the Manager and staff told me that this help had been invaluable. Whilst I noted a significant improvement in this area since my last visit it remains essential that this process is completed as soon as possible for each individual to help to promote their welfare and safety. Gallaudet Unit DS0000040658.V334870.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): 11, 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels within the home have now improved to ensure all service users have sufficient opportunities and appropriate support to access leisure and educational facilities both within the Poolemead site and wider community including holidays, day trips and visits to family and friends. EVIDENCE: Service users have the opportunity to attend daily Educational Development Studies (known as ‘EDS’). Each service user’s care plan I examined contained a two-week rota of planned activities, which included music, aromatheprty, art, craft and woodwork. Facilities available in the wider community are also used, including horse riding, swimming, shopping, going for walks, going on holiday, trips to local pubs and going out for meals. Gallaudet Unit DS0000040658.V334870.R01.S.doc Version 5.2 Page 14 During my visit, the service users spent most of their time outside the home, either at EDS or other community facilities. Staff spoken with and records examined show staffing levels have now improved and there is usually a minimum of three staff on each shift, with an additional staff member working a ‘mid shift’, usually from 9am till 4.30pm. This has helped to ensure that service users are able to choose when they would like to go out and where they wished to go. For example, on the first day of my visit a trip had been planned to visit Wookey Hole. There were also discussions between service users and staff regarding holiday plans and attending football matches. Service users who responded by survey said they ‘always’ made decisions about what they did each day. They also said they were able to do what they wanted during the day, evenings and weekends. Service users are supported to maintain regular contact with their family and friends and visitors to the home are welcomed. A record of all contact with family and friends is maintained. These show that service users are supported to visit their friends and family and also write to them, use mobile phone texting and contact them by telephone using a ‘minicom’ machine, which allows people who are deaf to type their message. Five relatives who responded by comment card said the home ‘always’ helps their relative to keep in touch with them and they are kept up to date with important issues, and one said ‘usually’. One relative said they were “very happy” with the home and another that “the home is absolutely wonderful”. Staff continue to work hard to ensure each service user is supported to choose, organise and attend a holiday. Holidays have been planned to Malta and Centre Parcs. Gallaudet Unit DS0000040658.V334870.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The review and improvement of care plans ensures that people that use this service can be assured that their personal and healthcare support needs are met and that the administration of medication ensures their welfare and safety. EVIDENCE: Each service user is registered with a local GP, Dentist, Optician and other relevant professionals. There are varying levels of support as necessary from other health care professionals. These are provided by Bridges Community Learning Disability Team. Contact with these professionals is recorded in each service users file and the outcomes acted upon. Gallaudet Unit DS0000040658.V334870.R01.S.doc Version 5.2 Page 16 Despite the new additions to the staff team, a core of experienced staff remain who have a good knowledge of service users’ health care needs. Staff would act on any concerns they have and would raise any areas of concern. I again observed staff interacting with service users within the home and it was evident that they are sensitive to the personal/healthcare and emotional needs of those living in the home. Health care records are now easier to track, as a new form has been introduced to monitor appointments and contact with health care professionals. In each care plan I examined these records had been completed clearly and consistently. Each service user is also now weighed regularly. The health care professional who responded by survey said the home ‘always’ met each service users health care needs and ‘usually’ seeks advice and acts upon this. They added the service was “contributing to service users well being and enhancing their lifestyle”. The home uses the Boots Monitored Dosage System of medication administration. The medication records show profiles of each service user, details of their medication, times of administration and manufacturers notes on some of the prescribed medications administered within the home. Staff have signed the medication policy and provided a sample of their initials, which they use on records. Two staff members are required to sign records each time medication is dispensed. Each of the service user’s records I examined were correctly recorded. One individual’s tablet had been dropped during staff administering this to them. This was clearly recorded on the administration records and the tablet correctly stored awaiting return to the pharmacy. Staff members have been provided with a variety of training opportunities, in relation to medication administration. They have an initial in-house assessment, some have attended ‘Boots’ Training, some ‘Aset’ Medication training and now the home supports staff through the ‘Protocol’ Training, which is accredited by the City of Bath College. This is in the style of an NVQ unit and contains four elements; introduction to medicines, care workers role, administration and medicines of differing client groups. Gallaudet Unit DS0000040658.V334870.R01.S.doc Version 5.2 Page 17 Gallaudet Unit DS0000040658.V334870.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are protected by staff that are mostly trained to ensure that they are protected from neglect, abuse and self-harm. Strategies and appropriate risk assessments are in place to guide staff when service users display behaviour that challenges the service being provided. The complaints procedure is supportive in the event of service users making a complaint. Record keeping has improved in these areas. EVIDENCE: The RNID has a comprehensive complaint policy and procedure in place. This is also available in symbol format within the home. The RNID also has an Adult Protection policy and procedure, which contains a step-by-step guide for staff to follow in the event of any allegation of abuse. Each service user who responded by Survey said they ‘always’ know how to make a complaint and staff ‘always’ listen to them and act on what they say. There have been two complaints recorded since the last inspection. The records showed that each complaint had been responded to in accordance with Gallaudet Unit DS0000040658.V334870.R01.S.doc Version 5.2 Page 19 the relevant policy. The outcomes had been recorded and the records were stored securely to ensure confidentiality. Four relatives who responded by comment card said they were aware of the home’s complaints procedure, while two said they ‘couldn’t remember’ this. Five relatives said the home ‘always’ responded appropriately to concerns they raised, while one relative said they ‘usually’ did. The home has now developed clear guidelines for supporting service users who are distressed or presenting behaviours which may be perceived as challenging the service provided. Each care plan has details of known trigger points and the appropriate defusing techniques. These are described as ‘Methods of Approach’. Both the RNID policy and the Department of Health Guidance on Restrictive Physical Interventions are also available in the home. During my last visit it was apparent that the recording of incidents of challenging behaviour were inconsistent. This has now improved with a new form introduced, which is completed after each incident. The checklist at the end of the form also helps to ensure staff complete all necessary records, such as the accident book, if this is necessary. Most forms I examined provided a clear record of each incident, together with staff responses and the outcome for the service user. However, all staff must remain clear in their reporting. One incident report said that two staff members “intervened” but this report does not describe the interventions used by the staff involved. This information is essential to promote the welfare and safety of both service users and staff and assist in the care planning and review process. Staff are provided with training in responding to challenging behaviour using the NAPPI (Non Abusive Psychological and Physical Intervention) system, which is accredited by the British Institute of Learning Disabilities. Since the last inspection, most of the staff team have now completed this training, with the remaining three staff undertaking training in June 2007. Staff spoken with welcomed this training and found it useful and informative. Staff are also provided with both Protection of Vulnerable Adults and Child Protection training. Three staff members who still require this training are due to attend two days training in June 2007. There is now a Risk Assessment in place for the one service user who requires physical intervention as part of their behavioural support plan. This was implemented in March 2007 however it still needs to be reviewed by the RNID Risk Manager and this must be completed as soon as possible. The Manager told me that no other service user has physical interventions as part of their care plan and that the issue of using restrictive physical Gallaudet Unit DS0000040658.V334870.R01.S.doc Version 5.2 Page 20 interventions would be discussed following staff training on the Mental Capacity Act. Gallaudet Unit DS0000040658.V334870.R01.S.doc Version 5.2 Page 21 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, 27 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Gallaudet provides a homely and comfortable environment for service users. EVIDENCE: Although not purpose built to meet the needs of service users, Gallaudet provides a homely environment. It is a self-contained unit, on the ground floor of the main Poolemead Building. There are large communal grounds on the Poolemead site and the home also has its own patio area, which can be accessed directly from many rooms within the home. The home has two communal lounges, a large conservatory area, dining area and kitchen. Each area is tastefully decorated, with several pictures fixed to the walls. There are also several photographs of service users and examples of their artwork, which are prominently displayed. This helps to personalise the home. Gallaudet Unit DS0000040658.V334870.R01.S.doc Version 5.2 Page 22 During my last visit new flooring had been laid in the shower room, however this needed to be attended to again due to the poor quality of workmanship. This work has now been completed and service users are now using this facility. The home was generally clean and tidy on both days of my visit. Staff told me that they try to ensure the home remains clean and tidy and involve the service users wherever possible. The home also employs a domestic assistant who was working in the home during my visit. Each service user who responded by survey said the home is ‘always’ fresh and clean. One relative said that Galluadet appeared to be “a happy home”. Gallaudet Unit DS0000040658.V334870.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 and 36. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s recruitment policy promotes both individual’s rights and their safety. Each person that lives in the home is supported by a cohesive staff team that is committed to providing a good service. The clarity of staff roles and responsibilities along with staff training and supervision helps to provide a more consistent approach to the support of staff and service users. EVIDENCE: Staff spoken with explained that the systems, structures, morale and dynamics within the home have all improved since the last inspection. Staff told me they had read the last CSCI inspection report and felt that it accurately reflected the service at that time and identified the issues, which needed to be addressed. Staff said that the management team are now providing clearer leadership in the development and improvements within the home. Staff also understand Gallaudet Unit DS0000040658.V334870.R01.S.doc Version 5.2 Page 24 their own roles and accountability. They feel their views are listened to, valued and taken seriously. Each support worker has now been given Keyworker responsibilities, with clear guidance provided in relation to this role. Staff spoken with felt this was a positive development and that they would have time to ensure these duties were carried out as their Keywork days had now resumed as new staff members had recently joined the team. Each member of staff spoken with felt that service users have again benefited from the significant improvements in morale and team working. Each felt the atmosphere within the home was much better and that they were all working as part of a team to ensure the service improved. The home has recently recruited Support Workers, to fill existing vacancies within the team. I spoke with two new members of staff who both told me they are enjoying their jobs, feel well supported in their role and spoke highly of their induction into the home. Each service user who responded by survey said staff ‘always’ treat them well. Four relatives who responded by comment card said the home ‘always’ gave their relative the care they would expect and that staff ‘always’ had the right skills and experience. Two said they felt this was ‘usually’ the case. One relative said “the care my relative receives is excellent and the communication is first class” and another said “the staff seem to be motivated and this reflects on the people living in the home”. Regular team meetings have now resumed. There is a clear record of each meeting and staff attendance was seen to be good. A variety of topics are discussed and the outcomes are clearly recorded. Staff told me they enjoyed the team meetings and always read the minutes if they were not able to attend. The home operates a robust recruitment process and the records I examined included application forms, job descriptions, two satisfactory references, documents confirming proof of identity, induction checklists and Enhanced Criminal Record Bureau Disclosures. The home has improved its record keeping in this area, by introducing an indexed filing system. I examined the training records for staff. These have been improved since the last inspection. Each staff member now has a training record which includes a schedule of training they have completed and copies of all relevant certificates are placed on file. The home also has a staff-training matrix, which is now kept up to date. Gallaudet Unit DS0000040658.V334870.R01.S.doc Version 5.2 Page 25 There have been a number of training opportunities for staff since the last inspection. Staff have attended First Aid, Food Hygiene, Protection of Vulnerable Adults, Child Protection, Challenging Behaviour training (the home currently uses the ‘NAPPI’ system), Communicating Transparently, Fire Safety, Health and Safety in the Workplace, Medication Administration, Risk Assessment and Working with People Who Self-Harm. The training schedule supplied by the Manager shows that a number of training opportunities are planned for staff in May and June 2007. This training includes both mandatory and specialist training courses. This training programme must be completed by all members of staff to help ensure they have the skills and abilities to provide appropriate support to each service user. Each staff member is now being supervised on a regular basis. Supervision of support workers is shared between the two seniors, who are in turn supervised by the Deputy Manager. A clear record of each supervision meeting is now maintained and each record is signed by the supervisor/supervisee. Staff spoken with again welcomed these regular, formal supervisions. They found them useful and supportive. Each member of staff told me these meetings were well planned and they felt able to discuss issues in an open and honest way. Gallaudet Unit DS0000040658.V334870.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, 38, 41, 42 and 43. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The leadership of the staff team within the home has now improved. This provides an improved support network for the service users and the staff team. The management systems and practices in place continue to be improved and are now used consistently. This helps to develop the quality of the service provided to the service users. The roles, responsibilities and accountabilities of each level of staffing are now clearer. This helps to ensure an effective and accountable management of the service for each service user. Organisational monitoring and support must remain robust. This will continue to promote a competent and accountable service for all stakeholders. Gallaudet Unit DS0000040658.V334870.R01.S.doc Version 5.2 Page 27 The procedures to promote and protect health, safety and welfare of the service users are being reviewed and improved. EVIDENCE: The current management team consists of the Registered Manager, Deputy Manager and two Senior Support Workers. They are supported by the RNID Residential Services Manager. The roles and responsibilities within the management team are now clearer and communication has improved. This team meet regularly to discuss issues relevant to the running of the home and the support provided to the service users. A clear record of each of these meetings is maintained, with outcomes acted upon. It is evident that this team has worked extremely hard to address the concerns raised in the last inspection report. There have been significant improvements made and it is clear that the management team is once again providing strong leadership within the home. This is actively supported and encouraged by the Residential Services Manager. All of the existing management systems and structures continue to be reviewed and improved upon. There are a number of examples such as care planning, Keyworking duties, staff training and supervision. Each development is clearly focused on improving the service for the people who live in the home and the working environment for the staff team. The management team have continued to visit other RNID services to examine their management systems. This appears to have been valuable in developing the new systems within Gallaudet. It would appear that this practice sharing is to continue. The Manager conducted an ‘Annual Self Audit’ on the service povided by the home in February 2007. A copy of this document has been supplied to the Commission. This document was only partially completed and was described as a more ‘reflective document’ by the Residential Services Manager. It was noted that a further audit will be completed by August 2007. The registered provider’s representative makes regular visits to the home, and produces a comprehensive report of his findings, which is send to the Commission on a monthly basis. Since the last inspection these visits have focused upon the improvements required within the service as well as more general issues. Gallaudet Unit DS0000040658.V334870.R01.S.doc Version 5.2 Page 28 The RNID Risk Manager has also recently conducted additional support and auditing visits to the service. The management team feel this additional support has been useful. The organisational monitoring and support remains an essential element in the development and improvements required within this service to ensure service users are provided with an effective and accountable service. There are recording systems in place to support Health and Safety within the home, which are generally being used consistently. Records examined included water temperature checks, fridge and freezer temperature checks and a visual safety check of all of the service users’ rooms. Fire safety within the home has been improved. Staff are now provided with inhouse training and the home’s fire log has been improved to make this easier for staff to use. The alarm system is tested weekly and there are regular checks on the emergency lighting, bed vibrators and fire doors. The fire officer last visited on 1/06/06. Two fire drills have been carried out and the names of each person involved in each drill are now clearly recorded. The records show however that some staff still need to take part in a fire drill and this must be addressed by the home. A generic risk assessment policy has been developed and the RNID Risk Manager is now actively supporting the home in this area as mentioned earlier within this report. There are currently twenty-five Risk Assessments in place, some generic and others relating to individual service users. There are many other assessments which have been completed and are awaiting approval from the Risk Manager. Whilst this is a significant improvement, these do not reflect all safe working practices within the home. This process must therefore be completed as soon as possible. Gallaudet Unit DS0000040658.V334870.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 3 2 X 3 X 4 X 5 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 3 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 2 33 3 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 x 2 3 X X 2 2 2 Gallaudet Unit DS0000040658.V334870.R01.S.doc Version 5.2 Page 30 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 YA6 Regulation 15 Requirement Each care plan must be subject to regular review. A clear record of the review process must be maintained. 2. YA23 1213(6) All staff must be provided with training in the Protection of Vulnerable Adults. (This requirement is repeated from the last three inspection reports) 3. YA42 13(4) Risk assessments on all safe working topics to be completed and be subject to regular review. 11/06/07 (This requirement is repeated from the last three inspection reports) 4. YA23 13(6) All staff must be provided with training in relation to responding to challenging behaviour. (This requirement is repeated from the last two Gallaudet Unit DS0000040658.V334870.R01.S.doc Version 5.2 Page 31 Timescale for action 11/07/07 12/06/07 15/06/07 inspection reports) 5. YA35 18(1)(c)(i) The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users ensure that the persons employed by the registered person to work at the care home receive training appropriate to the work they are to perform including structured induction training. All staff must be provided with training:Which meets all RNID core standards. Which provides all staff with additional relevant skills to support service users. (This requirement is repeated from the last two inspection reports) 15/06/07 6. YA42 23(4) Regular fire drills must be implemented. A clear record of each drill must be maintained. (This requirement is repeated from the last two inspection reports) 11/04/07 Gallaudet Unit DS0000040658.V334870.R01.S.doc Version 5.2 Page 32 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 Good Practice Recommendations The development of accessible formats for service users should continue to be reviewed by the home and a record kept as part of each care plan. The home should conduct a further review of quality care. 2. YA39 Gallaudet Unit DS0000040658.V334870.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Gallaudet Unit DS0000040658.V334870.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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