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Inspection on 14/06/06 for Gallaudet Unit

Also see our care home review for Gallaudet Unit for more information

This inspection was carried out on 14th June 2006.

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The staff remained 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.

What has improved since the last inspection?

All staff are now supervised on a regular basis and a clear, signed record of each meeting is now being maintained. This ensures all staff are supported to provide support to the service users. This means the enforcement notice issued in relation to supervision of staff will be signed off by CSCI as having been complied with. Staff are now being provided with both mandatory and specialist training. This process will take several months to complete. This will provide staff with the knowledge and skills to ensure each service user is supported appropriately. A clear plan detailing how staff are to be supported to gain a National Vocational Qualification has now been supplied to the Commission. This will help to ensure staff are supported in their professional development.A staff-training matrix has now been introduced and is maintained in good order. This helps to ensure all staff training can be effectively monitored. The Statement of Purpose is under review. Once completed, this document should accurately reflect the service provided and clearly communicate this to all readers of this document. The care planning and review process for each service users is being reviewed/improved. This will help to ensure that each service user is provided with appropriate care and support. The home has been redecorated in several areas and the carpets have been professionally cleaned. This helps to provide a more homely environment for service users. Regular fire drills and training have now been implemented. Weekly tests of fire equipment are now maintained. This promotes the safety and welfare of service users and staff. The improved concerns or complaints procedure will now ensure all issues are clearly recorded, together with details of the investigation process and outcomes. This will ensure service users views are listened to and acted upon and their safety and welfare is ensured. All staff are now aware of the organisational/home specific policies. This helps to ensure the welfare and safety of service users and staff. The Risk Assessment process is being reviewed/improved. This too helps to ensure the welfare and safety of service users and staff. Organisational monitoring and support of the service has been improved. This is helping to promote the safety of service users, improve service delivery and support the management team within the home. The Deputy Manager and senior support workers now show clear leadership in the delivery of consistent care for each service user and support for each member of the staff team. Effective management systems continue to be introduced.

What the care home could do better:

The amendments to the home`s Statement of Purpose must be completed. This document should accurately reflect the ethos, services, systems and procedures in place within the home. This will provide service users with relevant information regarding this service.The review/improvements in the care planning/review process must be completed for each service user. This will ensure a consistent approach in supporting each person. The staff training now planned in the Protection of Vulnerable Adults, Challenging Behaviour and other core/relevant specialist training must be completed by each member of the team. This is crucial in ensuring the safety and welfare of service users and in providing appropriate and consistent levels of support. The enforcement notice issued in relation to the training of staff has not yet been complied with but the timescales for doing so have yet to be reached and the prospects for achieving compliance are reasonable. The improvement/review of the Risk Assessment processes must be completed. This will ensure safe working practices are present within the home to ensure the welfare of service users and staff. The review/improvements in reactive strategies must be completed for all service users who present behaviour, which challenges the service. This will ensure consistency of approaches and ensure the safety of service users and staff. Risk Assessments must be implemented for service users who require the use of restrictive physical interventions. This will promote the safety and welfare of service users. Incidents of challenging behaviour, together with staff responses, must be clearly recorded. This must include restrictive physical interventions, if these are used. This will ensure clear records are maintained for each service users and promote the welfare. All concerns or complaints must be clearly recorded, together with details of the investigation process and outcomes. This will ensure service users` views are listened to and acted upon and their safety and welfare is ensured. The self-auditing tool for measuring the home`s success in achieving the aims and objectives must be reviewed, during the next audit process, to ensure the outcomes are evidence based. This will ensure the quality of the service provided is accurately measured. The progress in providing service users with information in a format which is accessible to them should be reviewed.

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 14 and 15th June 2006 09:00 th Gallaudet Unit DS0000040658.V300136.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.V300136.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.V300136.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 RNID Mrs Ruth J Young Care Home 8 Category(ies) of Sensory impairment (8) registration, with number of places Gallaudet Unit DS0000040658.V300136.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. 6th February 2006 Date of last inspection Brief Description of the Service: Gallaudet offers 9 single rooms to accommodate deaf people with special needs, including those with moderate physical disability. The environment is a single storey building surrounded by attractive gardens and grounds. The unit, which is part of a large complex incorporating other units, 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 unit employs a team of support workers, all with a range of sign language ability and experience. All bedrooms have a wash hand basin. Service users are able to lock their door if they wish, and a small number of people have a key to their room. Gallaudet unit is not tailored to meet the diverse needs of the service user group, and space is of a premium. The lounge area has been extended and now offers greater space for service users to relax in. All meals are now cooked on the unit and extended dining room space has been provided. The current fees range from £1100.00 to £2200.00 per week, depending on the particular support needs of service users. Gallaudet Unit DS0000040658.V300136.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 to the home carried out over two days. This visit formed part of a Key Inspection of this service. The inspector gathered information during this visit from discussions with the Deputy Manager, senior support workers, support workers and observation of interaction and support between staff and service users. Care plans and associated records were examined along with the Statement of Purpose, staffing, complaints and health and safety records. The inspector was also provided with a tour of all communal areas within the home. Other sources of information were also used as part of the Key Inspection process. These include the home’s action plan relating to the last CSCI inspection and ensuing enforcement notices; notifications of significant events; and reports of monthly audits of the service by the Residential Services Manager. What the service does well: What has improved since the last inspection? All staff are now supervised on a regular basis and a clear, signed record of each meeting is now being maintained. This ensures all staff are supported to provide support to the service users. This means the enforcement notice issued in relation to supervision of staff will be signed off by CSCI as having been complied with. Staff are now being provided with both mandatory and specialist training. This process will take several months to complete. This will provide staff with the knowledge and skills to ensure each service user is supported appropriately. A clear plan detailing how staff are to be supported to gain a National Vocational Qualification has now been supplied to the Commission. This will help to ensure staff are supported in their professional development. Gallaudet Unit DS0000040658.V300136.R01.S.doc Version 5.2 Page 6 A staff-training matrix has now been introduced and is maintained in good order. This helps to ensure all staff training can be effectively monitored. The Statement of Purpose is under review. Once completed, this document should accurately reflect the service provided and clearly communicate this to all readers of this document. The care planning and review process for each service users is being reviewed/improved. This will help to ensure that each service user is provided with appropriate care and support. The home has been redecorated in several areas and the carpets have been professionally cleaned. This helps to provide a more homely environment for service users. Regular fire drills and training have now been implemented. Weekly tests of fire equipment are now maintained. This promotes the safety and welfare of service users and staff. The improved concerns or complaints procedure will now ensure all issues are clearly recorded, together with details of the investigation process and outcomes. This will ensure service users views are listened to and acted upon and their safety and welfare is ensured. All staff are now aware of the organisational/home specific policies. This helps to ensure the welfare and safety of service users and staff. The Risk Assessment process is being reviewed/improved. This too helps to ensure the welfare and safety of service users and staff. Organisational monitoring and support of the service has been improved. This is helping to promote the safety of service users, improve service delivery and support the management team within the home. The Deputy Manager and senior support workers now show clear leadership in the delivery of consistent care for each service user and support for each member of the staff team. Effective management systems continue to be introduced. What they could do better: The amendments to the home’s Statement of Purpose must be completed. This document should accurately reflect the ethos, services, systems and procedures in place within the home. This will provide service users with relevant information regarding this service. Gallaudet Unit DS0000040658.V300136.R01.S.doc Version 5.2 Page 7 The review/improvements in the care planning/review process must be completed for each service user. This will ensure a consistent approach in supporting each person. The staff training now planned in the Protection of Vulnerable Adults, Challenging Behaviour and other core/relevant specialist training must be completed by each member of the team. This is crucial in ensuring the safety and welfare of service users and in providing appropriate and consistent levels of support. The enforcement notice issued in relation to the training of staff has not yet been complied with but the timescales for doing so have yet to be reached and the prospects for achieving compliance are reasonable. The improvement/review of the Risk Assessment processes must be completed. This will ensure safe working practices are present within the home to ensure the welfare of service users and staff. The review/improvements in reactive strategies must be completed for all service users who present behaviour, which challenges the service. This will ensure consistency of approaches and ensure the safety of service users and staff. Risk Assessments must be implemented for service users who require the use of restrictive physical interventions. This will promote the safety and welfare of service users. Incidents of challenging behaviour, together with staff responses, must be clearly recorded. This must include restrictive physical interventions, if these are used. This will ensure clear records are maintained for each service users and promote the welfare. All concerns or complaints must be clearly recorded, together with details of the investigation process and outcomes. This will ensure service users’ views are listened to and acted upon and their safety and welfare is ensured. The self-auditing tool for measuring the home’s success in achieving the aims and objectives must be reviewed, during the next audit process, to ensure the outcomes are evidence based. This will ensure the quality of the service provided is accurately measured. The progress in providing service users with information in a format which is accessible to them should be reviewed. 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. Gallaudet Unit DS0000040658.V300136.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.V300136.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1. The quality in this outcome area is poor. The home has a Statement of Purpose available. This must be updated and amended to ensure it provides accurate information for all service users. EVIDENCE: The Statement of Purpose is detailed and has had some minor amendments since the last inspection, such as room sizes being added. There is no evidence however this has been reviewed every six months, as the document states. The deputy manager told the inspector that this document will be completely reviewed and amended to ensure it clearly reflects the service provided. A copy of this amended document will be provided to the Commission once completed. It is anticipated that the new Statement of Purpose will be available in an accessible format as the current document is not in Braille or any other format other than written English. Gallaudet Unit DS0000040658.V300136.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. The quality in this outcome area is adequate. Care plans are reviewed and updated annually. Service users are supported to participate in this process. All aspects of the care planning and review process are being reviewed and improved. Staff provide service users with information and encourage them to make informed choices wherever possible. The home is reviewing its progress in providing information in accessible formats. The Risk Assessments process in place is designed to ensure service users welfare and safety. This system is being improved to ensure service users are supported to take risks as part of their lifestyle. EVIDENCE: Three care plans were examined in detail by the inspector and these provided sufficient information on the areas of support each person required. Each service user now has an “Evidence Folder” and “Daily Records” files. These now contain clear records. Gallaudet Unit DS0000040658.V300136.R01.S.doc Version 5.2 Page 11 Each care plan is in the process of being thoroughly reviewed and updated. New files have been purchased, a clearer system of sectioning each file is being introduced and a great deal of historical information has been removed and securely archived. Once this process is completed the care planning and storage of information will be significantly improved. Staff spoken with confirmed that each service user now has a Keyworker. Staff are clear regarding their Keyworker responsibilities and feel the “care team meetings” recently introduced will help to ensure each care plan is kept under constant review. Staff feel empowered by this process, as they now have responsibility delegated to them. There have been a number of recent review meetings, with others scheduled later this month. Each review meeting has been recorded and these records clearly explain the discussions at each meeting and the outcomes. Once these improvements are implemented/completed for each service user, all care plans will be reviewed at least every six months or sooner if service user support needs change. During the course of the inspection the inspector 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. The inspector observed British Sign Language and clear speech being used. There are also pictures/picture symbols in use and some information has been adapted into the Widget format. The deputy manager told the inspector that although there were a number of urgent issues being attended to, they are reviewing and trying to develop the accessible formats to support service users to access information. Each member of staff spoken with told the inspector of the considerable improvements within the home which has led to a more consistent approach in supporting the service users. Staff also feel that service users have benefited, especially from the improved morale and team working. Several staff feel service users are more relaxed and confident now. There are person centred Risk Assessments in place for some service users, which support them to take risks as part of their lifestyle. All of the risk assessments are currently being reviewed by one of the senior support workers, who is confident and experienced in this role. He showed the inspector a number of updated assessments which had been recently reviewed and explained the remainder will be updated as soon as possible. Gallaudet Unit DS0000040658.V300136.R01.S.doc Version 5.2 Page 12 Once this process is completed it will be a valuable and essential element in enabling the home to ensure the welfare and safety of the vulnerable adults who live in the home. Gallaudet Unit DS0000040658.V300136.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14 and 15. The quality in this outcome area is adequate. Service users are able to take part in appropriate activities and educational courses with the support of the staff team. Service users are supported by staff to use facilities both within the Poole mead site and in the wider community. They are also supported to enjoy holidays, day trips and visits to family and friends. The staffing within the home continues to be reviewed to ensure all service users have sufficient opportunities and appropriate support to access leisure and educational facilities. EVIDENCE: Service users have the opportunity to attend daily Educational Development Studies. Facilities available in the wider community are also used, including horse riding, shopping, going for walks, going on holiday, trips to local pubs and going out for meals. Gallaudet Unit DS0000040658.V300136.R01.S.doc Version 5.2 Page 14 During the inspection service users were supported to go out for lunch, go to the cinema and to shop at the local market. One service user told the inspector he was going to the pub to watch England’s world cup match that evening. Staff are currently supporting another service user on holiday in Cornwall. The daily records examined did show varying levels of activities for service users. Staff spoken with explained that staffing levels had improved. There are now staff working mid shifts each weekday, although not on weekends as yet. The rota for a four-week period confirmed this. This additional staffing has enabled staff to offer each individual more opportunities, especially accessing the wider community. This is a positive development. The home is working towards developing a more person centred approach in the support it offers. Ensuring sufficient staffing levels, including weekends, is central to this process. The staffing levels maintained within the home are now therefore kept under review to ensure that all service users are offered opportunities and appropriate support to enable them to enjoy a range of activities, both within the home and in the wider community. This is in accordance with the planned development and improvement of the service. The deputy manager told the inspector that the menu planning is currently being reviewed. The new menu plans were not available during this visit and therefore could not be assessed. The inspector did discuss the locking away of food in the kitchen area with staff members. The reasoning for this appears sound and in the best interests of service users, but it is recommended that a Risk Assessment be completed in relation to this measure. Gallaudet Unit DS0000040658.V300136.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 and 19. The quality in this outcome area is adequate. The care plans explain the support each service user requires in relation to their personal and health care. However, all care plans are undergoing review/improvement. EVIDENCE: Each service user is registered with a local GP, Dentist and other relevant professionals. There are varying levels of support as necessary from other health care professionals. Each care plan is currently being reviewed/improved. Health care records are now easier to track, as a new form has been introduced to monitor appointments and contact with health care professionals. These now show the outcomes and this information is used as part of each service user review. Regular weighing of service users has been reintroduced and some service users are having their blood pressure monitored, if this is appropriate for them. Gallaudet Unit DS0000040658.V300136.R01.S.doc Version 5.2 Page 16 Staff spoken with felt the continuing improvement in care planning and monitoring is a positive development as this helps to ensure consistency in supporting each service user and that any changes in service user health are now noted and acted upon. Gallaudet Unit DS0000040658.V300136.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. The quality in this outcome area is poor. The complaints procedure is designed to be supportive in the event of service users making a complaint. A clear record of each complaint must be maintained. All staff must be provided with appropriate training to ensure service users are protected form neglect, abuse and self-harm. All staff have now read and understood the RNID policy and procedure relating to adult protection and challenging behaviour. Clear reactive strategies, incident recording and Risk Assessments must be implemented for each service user who presents challenging behaviour. EVIDENCE: The RNID has a comprehensive complaint policy and procedure in place. This is also available in symbol format within the home. This has now been been updated to ensure the correct details of the contact at CSCI is available to all service users. There have been no complaints recorded since the last inspection: however the complaint made by a service user in October 2005, referred to in the last CSCI inspection report, has still not been located by the home. The complaint process and outcomes in relation to this issue still cannot therefore be assessed. Gallaudet Unit DS0000040658.V300136.R01.S.doc Version 5.2 Page 18 It is essential that any complaints are recorded and stored in line with the Regulations and RNID Policy. These records must be made available for inspection. This will ensure a safe and accountable system is in place for service users. This remains an outstanding requirement from the last two CSCI inspections. Staff training records show that some staff members have received training in the Protection of Vulnerable Adults and responding to challenging behaviour, using the NAPPI system. Training for staff in this area is mandatory, however significant failings were identified during the last inspection. The inspector examined records of three recent incidents of challenging behaviour. These described behaviours such as service users hitting out at staff, pulling their hair and attempting environmental damage. One report describes staff “assisting with removing..” a service user, however how this was achieved was not recorded. None of the staff supporting service users during these incidents have received training in responding to challenging behaviour or intervention techniques. This presents significant risks to service users and the staff team. The home has now provided a training plan, which confirms that Protection of Vulnerable Adults training is due to provided to four staff this month and another four staff in August 2006. Abuse Awareness and Reducing Risk of Abuse training is scheduled for six staff in August 2006. NAPPI training is scheduled for two staff this month, five staff in July 2006 and six staff in August 2006. This training remains an essential element in providing a safe and accountable service. The Deputy Manager has now introduced a policy file, where RNID or home specific policies are kept. Each staff member had signed to confirm they had read the policies relating to the Protection of Vulnerable Adults and Challenging Behaviour. Discussions with members of the staff team confirmed this. The home uses ‘methods of approach’ to describe the support each service user will require and the techniques to be used by staff. Both the RNID policy and the Department of Health Guidance on Restrictive Physical Interventions are available in the home. The Deputy Manager told the inspector these were yet to be reviewed. He has asked for support in this area from a colleague who provides staff training in the NAPPI system. The review of all methods of approach will therefore be carried out shortly. The incident reports should also be reviewed as part of this process as they do not provide a clear record of each incident. They do not describe antecedents, setting conditions, interventions used, timescales or outcomes. This is inadequate and not in accordance with RNID Policy. Gallaudet Unit DS0000040658.V300136.R01.S.doc Version 5.2 Page 19 There are no Risk Assessments in place for service users who require physical intervention as part of their behavioural support plan, however these will be developed as part of the improvements in assessing risks within the service. These are described as essential in both the RNID Policy and the Department of Health Guidance. These must be implemented, communicated to all staff members and regularly reviewed. Gallaudet Unit DS0000040658.V300136.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27 and 30. The quality in this outcome area is adequate. Gallaudet now provides a homely and comfortable environment for service users. There have been several improvements since the last inspection. The home was clean and tidy during the inspector’s visit. EVIDENCE: The home was generally clean and tidy on both days of the inspector’s visit. Several areas of the home have been redecorated. The communal corridor area has particularly benefited from this process. Staff told the inspector that all of the service users had been involved in this process and had chosen the colour schemes. The lounge area as you enter the home is currently being improved. There are plans to move the furniture in this room to enable service users and staff to face each other when sitting in this area. This will help each person to communicate through sign language. There are three different ways this may be achieved and service users are being encouraged to choose which they like best. Gallaudet Unit DS0000040658.V300136.R01.S.doc Version 5.2 Page 21 Plans to update and modernise all bathrooms have been submitted to the RNID for approval. This appears to be a longer-term plan in developing the service, therefore these rooms have been repainted and this has improved their appearance. The carpets have been professionally cleaned, which has greatly improved their appearance. This process is due to be repeated within the next week. This will include all communal areas of the home and the carpet in each service users bedroom. The padlocks, which were fitted on several of the cupboard doors in the kitchen area, have been removed. New locks have been fitted which have improved the appearance of the kitchen. Staff explained that the oven is not working and that this is being replaced within the next few days. The central kitchen on the Poolemead site was supporting the home by providing meals until the new oven is fitted. Staff spoken with told the inspector that they had obtained funds from the RNID amenities fund, which will be used to purchase new lighting and pictures to complete the improvements made to the communal areas of the home. Gallaudet Unit DS0000040658.V300136.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 and 36. The quality in this outcome area is adequate. The Deputy Manager and Senior Support Workers are providing leadership in the development/improvements within the service. The staff team has become more cohesive and effective in supporting the service users. Training has been planned for all staff in accordance with National Minimum Standards and RNID Policy. A clear and up to date record of all staff training is now maintained. An action plan in relation to supporting staff to obtain a National Vocational Qualification has been devised, to support staff in their professional development. All staff are now supervised on a regular basis and a clear record is maintained in their personnel files. Gallaudet Unit DS0000040658.V300136.R01.S.doc Version 5.2 Page 23 EVIDENCE: Staff spoken with explained that the systems, structures, morale and dynamics within the home had all greatly improved since the last inspection. Each member of staff told the inspector 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 spoke highly of the Deputy Manager and the Senior Support Workers, who have provided leadership in the development and improvements within the home. Staff now clearly understand their roles and accountability. They feel empowered, their views valued and taken seriously. Each support worker has now been given Keyworker responsibilities. Staff spoken with felt this was an extremely positive development and helped to ensure that a more person centred approach to service user care and support is adopted and it gave them some autonomy within their roles. Each member of staff spoken with felt that service users have benefited from the significant improvements in morale and team working. Each felt the atmosphere within the home was much better than before and that they were all working as part of a team to ensure the service improved. The inspector viewed the training records for staff. These have been greatly improved. 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 training schedule supplied to the Commission shows that a number of training opportunities are planned for staff from March-August 2006. This training includes both mandatory and specialist training courses. This is an important development to help ensure all staff have the skills and abilities to provide appropriate support to each service user. The home currently has seven staff members working towards their NVQ Level 3 or 4. This is being supported by the RNID Regional Training Manager and external NVQ Assessors provided by Norton Radstock College. Staff have time identified on the rota relating to NVQ study time. At present staff are provided with an average of 2 to 3 hours per month. Staff spoken with welcomed the improvement in training opportunities. The now had confidence in this process and felt that when they are due to attend training this would happen, rather than being cancelled at short notice, which had happened in the past. Gallaudet Unit DS0000040658.V300136.R01.S.doc Version 5.2 Page 24 The inspector viewed the supervision and appraisal records for seventeen members of staff. 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 the inspector these meetings were well planned and they felt able to discuss issues in an open and honest way. There are regular team meetings, which usually take place each Wednesday. There is a clear record of each meeting and staff attendance was seen to be high. A variety of topics are discussed and the outcomes are clearly recorded. Staff told the inspector they enjoyed the team meetings and they are also planning a team away day to help build on the improved morale and team working. Gallaudet Unit DS0000040658.V300136.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 42 and 43. The quality in this outcome area is adequate. The leadership of the staff team both within the home and from the organisation has been significantly improved. This helps to ensure an effective support network for the service users and the staff team. The management systems and practices are being reviewed/improved. All changes are being clearly communicated throughout the team to ensure understanding. This helps to ensure the quality of the service provided to the service users. The annual Quality Assurance audit process must be improved to ensure the views of service users and other stakeholders are reflected and that the outcomes are evidence based. There are systems and structures in place to ensure the welfare and safety of service users and staff. These are currently subject to review and improvement. Gallaudet Unit DS0000040658.V300136.R01.S.doc Version 5.2 Page 26 EVIDENCE: The registered manager of the service has been absent from work for several weeks due to illness. The Commission has been kept fully informed of the manager’s absence and the measures put in place for the management of the home in her absence. The current management team therefore consists of the Deputy Manager and two Senior Support Workers. They are supported by the RNID Residential Services Manager. 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 in a relatively short time and it is clear that there is now strong leadership within the home, particularly by the Deputy Manager, and this is actively supported and encouraged by the Residential Services Manager. All of the existing management systems and structures have been reviewed and either already improved upon or improvements planned. There are a number of examples such as care planning, review processes, 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 Deputy Manager told the inspector that he and the senior support workers have visited other RNID services to examine their management systems. This has been of great benefit in developing the new systems now being implemented within Gallaudet. The management team now in place wish to continue this practice sharing, as this is valuable to them. The Quality Assurance review commented upon in the last inspection report has been reviewed by the organisation. Both the Commission and the RNID agree that several of the outcomes were not evidence based. The next review is scheduled for December 2006/January 2007. It is essential that when this review is conducted the outcomes reflect the available evidence and that views of all stakeholders are represented. This will help to ensure the service remains committed to improvement and is accountable to its stakeholders. A generic risk assessment policy has been developed and there was evidence to show that risks assessment for all safe working practices are being reviewed and updated as required at the last inspection. One senior support worker is leading this development as previously mentioned in this report. Gallaudet Unit DS0000040658.V300136.R01.S.doc Version 5.2 Page 27 Fire safety within the home has been improved. Staff are now provided with inhouse training and the home’s fire log is in 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 and the Deputy Manager told the inspector an evacuation drill was carried out on this day. This fire drill however had not been recorded in the fire log. There is currently no Fire Risk Assessment in place and this must be developed in line with the general improvements in the home’s risk assessment processes. The RNID Health and Safety Manager has recently been asked to conduct an audit of the service. Following his visit a comprehensive action plan has been devised, which details several improvements required in this area. A copy of this report was provided to the inspector and it is evident that the Deputy Manager is working hard to implement the improvements described in this report. This is a positive development. Gallaudet Unit DS0000040658.V300136.R01.S.doc Version 5.2 Page 28 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 X 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 1 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 X 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 2 15 3 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 X X 3 2 2 X X 2 2 Gallaudet Unit DS0000040658.V300136.R01.S.doc Version 5.2 Page 29 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 Sch 1 Requirement Statement of purpose must be amended: a) To comply with National Minimum Standards. b) To accurately reflect the home’s service, ethos, systems and procedures. (This requirement is repeated from the last inspection report) 2. YA6 15 All care plans must be reviewed and updated. A copy of care plans to be given to service users or their relatives. 15/09/06 Timescale for action 15/08/06 3. YA33 18(1) (This requirement is repeated from the last inspection report) Staffing levels to be reviewed to 15/06/06 ensure service users opportunities are not unnecessarily limited. (This requirement is repeated from the last inspection report) Gallaudet Unit DS0000040658.V300136.R01.S.doc Version 5.2 Page 30 4. YA22 22 All complaints made must be recorded and stored securely. 15/06/06 5. YA23 13(7) (This requirement is repeated from the last inspection report) Improve Behavioural 15/09/06 Management Strategies and associated Risk Assessments to ensure the safety and welfare of service users and staff. (This requirement is repeated from the last inspection report) All staff must be provided with 15/09/06 training in relation to responding to challenging behaviour. All staff must be provided with training in the Protection of Vulnerable Adults. 15/09/06 6. YA23 13(6) 7. YA23 12 13(6) 8. YA35 18(1) (This requirement is repeated from the last inspection report) 15/09/06 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 inspection report) 15/12/06 The Quality Assurance audit process must be improved and outcomes evidenced. (This requirement is repeated from the last inspection report) 9. YA39 24 12(3) Gallaudet Unit DS0000040658.V300136.R01.S.doc Version 5.2 Page 31 10. YA42 13(4) Risk assessments on all safe working topics to be completed and be subject to regular review. 15/09/06 11. YA42 23(4) (This requirement is repeated from the last inspection report) Regular fire drills must be 15/06/06 implemented. A clear record of each drill must be maintained. 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. Gallaudet Unit DS0000040658.V300136.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Gallaudet Unit DS0000040658.V300136.R01.S.doc Version 5.2 Page 33 - 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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