Inspection on 16/11/06 for Gallaudet Unit

This inspection was carried out on 16th November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Gallaudet Unit 11/04/07

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 Unannounced Inspection 16 and 24th November and 7th December 09:40 th DS0000040658.V320062.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 DS0000040658.V320062.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. DS0000040658.V320062.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 DS0000040658.V320062.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. 14th June 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. DS0000040658.V320062.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 Risk Assessments, accident/incident reports, complaints log 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, the providers own monthly auditing of the service and notifications of significant events which have occurred within the home. This inspection was concluded with a separate meeting with the Registered Manager, Deputy Manager, Residential Services Manager and myself on the 7th December 2006. What the service does well: What has improved since the last inspection? The amendments to the home’s Statement of Purpose have now been completed. This document now provides all stakeholders with relevant information regarding this service. DS0000040658.V320062.R01.S.doc Version 5.2 Page 6 All concerns or complaints are now clearly recorded, together with details of the investigation process and outcomes. This helps to ensure service users’ views are listened to and acted upon and their safety and welfare is promoted. What they could do better: 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. Medication administration must be improved. This will help to promote the welfare and safety of each service user. 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 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 been complied with within the prescribed timescale and although this timescale has been extended, further lack of compliance would have to give rise to consideration of other enforcement options including prosecution. The improvement/review 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. 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 promote 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 user and promote their welfare and safety. The continued shortfalls in risk assessing and recording of challenging behaviour present significant risks to service users and the staff team. Consequently an enforcement notice will be drawn up and served. DS0000040658.V320062.R01.S.doc Version 5.2 Page 7 All staff must be supervised regularly and a clear record of each meeting must be maintained and made available for inspection. This will ensure all staff are supported to provide appropriate support to each service user. The management team must 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 must be used consistently. This will help to provide a more consistent and responsive service for each person who lives in the home and improve support for the staff team. 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 organisation must ensure that these significant problems in the delivery of the service that are recognised in monitoring visits are actually addressed and resolved. 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. DS0000040658.V320062.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 DS0000040658.V320062.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 Statement of Purpose now provides accurate information about the service but is not yet available in alternative more accessible formats. All service users need to be provided with a statement of terms and conditions, relating to living in the home. EVIDENCE: The Statement of Purpose is detailed and has been amended since the last inspection. The current document was last updated in November 2006, and it is noted that this will be updated every six months. This is commended. It was anticipated that the new Statement of Purpose would be made available in an accessible format. However, the current document is not in any other format other than written English. DS0000040658.V320062.R01.S.doc Version 5.2 Page 10 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. DS0000040658.V320062.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans provide necessary information to staff to enable them to understand service users’ needs and support those needs. Improvements to the process of actively reviewing care plans with the involvement of service users need to be sustained. Staff provide service users with information and encourage them to make informed choices wherever possible. The home continues to review 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. These improvements must be completed. DS0000040658.V320062.R01.S.doc Version 5.2 Page 12 EVIDENCE: I examined three care plans in detail and these provided sufficient information on the areas of support each person required. Each service user has an “Evidence Folder” and “Daily Records” files. The ‘Evidence Folder’ contains a profile of the service user, needs assessment documentation and their plan of care. This covers relevant areas of support such as daily living skills, communication, family contact and daily routines. The ‘Daily Records’ provide a summary of each service user’s day. 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. It was not apparent how the home is ensuring that each care plan is reviewed at least twice a year. The “care team meetings”, involving the service users and their Keyworkers, recently introduced appear to have ceased. These were designed to ensure all care plans were regularly reviewed and updated and without this process, it is not apparent there are any other means to ensure these reviews are conducted. The Manager told me that Keyworkers were reading through care plans and have been asked to discuss any changes which need to be made during their supervision meetings. It is however apparent that not all service users currently have Keyworkers, due to staff vacancies and shortages due to sickness. Also, staff supervisions have become irregular. This appears to leave some service user care plans without any review process other than the annual review. During the course of the inspection 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 and clear speech being used. There are also pictures/picture symbols in use and some information has been adapted into the Widget format. 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 remain limited to only three of the service users who live in the home. The DS0000040658.V320062.R01.S.doc Version 5.2 Page 13 assessments, which are in place, are limited in their scope. This process must be completed for each individual to help to ensure their welfare and safety. DS0000040658.V320062.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 and 17. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. 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 Poolemead 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 must be reviewed/improved to ensure all service users have sufficient opportunities and appropriate support to access leisure and educational facilities. DS0000040658.V320062.R01.S.doc Version 5.2 Page 15 EVIDENCE: Service users have the opportunity to attend daily Educational Development Studies. Each service user care plan 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. During my visit, the service users spent most of their leisure time in the home. The daily records examined did show varying levels of activities for service users. Staff spoken with explained that staffing levels had declined and due to staff shortages, sometimes service users were not able to choose whether to go out or stay at home. The staffing levels can be as little as two staff on duty, which effectively means that staff cannot leave the home to support service users in the community. During my last visit it was evident the home was working towards developing a more person-centred approach in the support it offers. Ensuring sufficient staffing levels, including weekends, was central to this process and it is clear during this visit that both the vacancies within the staff team and staff sickness are having an adverse effect on the opportunities for each service user. Staff spoken with told me that service users had previously begun to show signs of positive change, for example one service user who had rarely chosen to go out was accessing community facilities, although this is now restricted due to staffing levels. One staff member said they thought some service users were ‘going backwards’, another that ‘service users are bored, they can’t go out’ and another that ‘things are falling apart’ for them. Service users are supported to maintain regular contact with their family and friends and visitors to the home are welcomed. Staff have worked hard to ensure each service user is supported to choose, organise and attend a holiday. There have been recent holidays to Disneyland Paris, the Isle of Wight and Cornwall. Observation during my visit and discussion with staff evidenced that each person who lives in the home is treated with respect and dignity. Each person is seen as an individual and treated as such. During my last visit I was told the menu planning was being reviewed. Although the menu on display promotes a healthy and balanced diet, this was DS0000040658.V320062.R01.S.doc Version 5.2 Page 16 to be produced in picture form to support service users. During this visit the menus remain written in English, with no pictures or symbols. At my last visit I also discussed the locking away of food in the kitchen area with staff members and recommended that a Risk Assessment be completed in relation to this measure. This has not been completed. DS0000040658.V320062.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care plans explain the support each service user requires in relation to their personal and health care. All care planning has been reviewed. These improvements must be completed. Medication administration must be improved to ensure the welfare and safety of service users. 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. These are provided by Bridges Community Learning Disability DS0000040658.V320062.R01.S.doc Version 5.2 Page 18 Team. Contact with these professionals is recorded in each service users file and the outcomes acted upon. Despite the staff shortages, a core of experienced staff remains 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 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 designed to be easier to track, as a new form has been introduced to monitor appointments and contact with health care professionals. However, it appears that recently record keeping in this area has become inconsistent. I noted for example one service user’s ‘priority goal’ from June 2006 was to eat more healthily, reduce their weight and take regular exercise. The weekly weight records had only been completed during August 2006. All subsequent weekly records were left blank and therefore it was not possible to track the progress towards this goal. The review of care plans in this area is similar to the review process described earlier within this report. It is therefore not consistent with being reviewed at least every six months. 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 are provided with a variety of training opportunities. They have an initial in house assessment, some have attended Boots MDS Training, some Aset Medication training and now the home supports staff through the ‘Protocol’ Training. On the first day of my visit, three service users had medication missing from individual blister packs. It was not apparent what had happened to this medication and there were no records to explain this. This was discussed with the Manager, who agreed the records had not been completed to explain this discrepancy. DS0000040658.V320062.R01.S.doc Version 5.2 Page 19 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 poor. This judgement has been made using available evidence including a visit to this service. The complaints procedure is designed to be supportive in the event of service users making a complaint. A clear record of each complaint is now maintained. All staff must be provided with appropriate training to ensure service users are protected from neglect, abuse and self-harm. 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. There has been one complaint recorded since the last inspection. This referred to a general issue and was not related to the Gallaudet unit. The Deputy Manager wrote to the complainant to explain this. The missing complaint made by a service user in October 2005, referred to in the last CSCI inspection report, has now been located by the home. I noted DS0000040658.V320062.R01.S.doc Version 5.2 Page 20 that this service user confirmed in writing that they did not wish to use the formal complaints procedure regarding these issues. I examined service users’ daily notes and incident recording. It is apparent that the recording of challenging behaviour remains inconsistent. One service user’s daily notes detail them ‘grabbing’, ‘hitting out’, ‘punching’ and ‘head butting’, but no incident reports had been completed in relation to any of these behaviours and staff have offered no information within the daily notes of how they responded to these. The Manager told me that the staff are ‘complacent’ in recording these incidents. Some staff would record these incidents, where others would not. There is no evidence that this issue has been addressed with the staff team. The incident reports which remain in use should be reviewed, as they do not provide a clear record of each incident. They do not describe antecedents, setting conditions, interventions used, timescales or outcomes. This remains inadequate and not in accordance with RNID Policy. 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. During the last inspection the Deputy Manager confirmed each method of approach would be reviewed and improved wherever possible. This process was to be supported by the organisation’s training officer. I noted however that methods of approach remain unclear and, in one care plan, vital information is missing. The Deputy Manager told me that the training officer has not yet been able to support the home in this area. One method of approach examined described the service user’s self-injurious behaviour and stated that physical intervention ‘may become necessary’. It did not describe any appropriate techniques staff are able to use use. Another method of approach stated physical intervention could be used and referred to this service user’s ‘physical intervention guide’. I examined this guide and found it to contain no plan for this service user at all, only the RNID and Department of Health Guidance described above. Discussions with this service user’s Keyworker confirmed this, who could not locate the guide either. The Manager told me she thought these were being reviewed, but was not aware they were no longer within the relevant file. She could not confirm what techniques were currently being used by staff members, or what guidelines they are following. There are no Risk Assessments in place for service users who require physical intervention as part of their behavioural support plan, despite these being DS0000040658.V320062.R01.S.doc Version 5.2 Page 21 required following the last two CSCI inspections. 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. The continued shortfalls in care planning, risk assessing and recording of challenging behaviour present significant risks to service users and the staff team. Consequently an enforcement notice will be drawn up and served. DS0000040658.V320062.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27, 28 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Gallaudet provides a homely and comfortable environment for service users. There have been improvements since the last inspection but further work is needed. The home was clean and tidy during my visit. EVIDENCE: There have been some improvements to the home since my last visit. New carpets have been fitted in all communal areas and several pictures have been fixed to the wall. There are now several photographs of service users, which are prominently displayed. This helps to personalise the home. DS0000040658.V320062.R01.S.doc Version 5.2 Page 23 New flooring has been laid in the communal toilet and the shower room, however this room will need to be attended to again due to the poor quality of workmanship. This facility is therefore currently not available to service users. 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. However, due to staff shortages this is not always possible. The home’s domestic is currently absent from work due to sickness. The home has contracted external cleaning contractors to support both service users and staff until this member of staff returns. The Manager told me that any further plans to develop and improve the environment would be longer-term goals. DS0000040658.V320062.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 and 36. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The staff team remain committed to providing a good quality service to each person who lives in the home. However, issues within the staff team impact adversely on the quality of the service the home provides. Staff roles and responsibilities need to be clarified within the existing staffing structure. This would provide a more consistent approach in supporting both the staff and service users. Training has been planned for all staff in accordance with National Minimum Standards and RNID Policy. This training programme must be completed by each staff member. All staff must be supervised on a regular basis and a clear record maintained in their personnel files. DS0000040658.V320062.R01.S.doc Version 5.2 Page 25 EVIDENCE: The recent shortages within the staff team have had an effect on the quality of service, however the core of staff who remain have worked hard during this difficult time to limit these effects. Staff spoken with explained that the improvements in working methods and morale noted at the last inspection had unfortunately not lasted. Staff told me that the care plans and methods of approach are not strictly adhered to. Also, record keeping is inconsistent. Staff spoken with told me the morale within the team has declined and staff are not as confident regarding the development and improvement of the service as they were. The shortages within the staff team appear to be a significant factor. Staff told me that there are often now only two staff on duty, where a few months ago there may have been three staff plus two additional mid shifts. Staff also regularly work with relief and agency staff, which appears to add to the pressure staff feel working in the home. Staff told me they find it ‘stressful’ and one explained to me they had recently returned from sick leave due to stress. Other staff members describe the atmosphere as ‘lots of negativity’, ‘a division within the team’ and ‘felt improvements had stopped’. Staff have been recently recruited to fill vacant posts and will commence employment as soon as all necessary employment checks are completed. It is also hoped that one member of staff currently on sick leave will return within the next week. The other significant factors described by staff were the lack of clear roles, responsibilities and leadership within the home and the deterioration in the lines of communication. Staff feel that since the Manager has returned from sick leave the roles and responsibilities within the management team are not as defined as before and this has reduced their confidence. Staff told me they ‘are not sure of their own role’, that the management team ‘are not very approachable now’ and they appear to be ‘treading on each others toes’. Also, the communication within the home has deteriorated as both team meetings and staff supervisions have become irregular. The team meeting held on 12/07/06 was the most recent record I could find, when during my last visit these were being held weekly. The Manager told me a ‘Team Day’ was held on 8/08/06, although this was not recorded in the team meeting minutes file. DS0000040658.V320062.R01.S.doc Version 5.2 Page 26 Supervision of support workers is shared between the two seniors, who are in turn supervised by the Deputy Manager. Each senior maintains a log of 1:1 supervision dates with staff members. I was only able to examine one supervisor’s log during my visit, as the other one could not be located on either day of my visit. This one log confirmed that supervisions had become irregular, as staff had last been supervised during July and August 2006. I viewed the training records for staff. Each staff member has a training record which includes a schedule of training they have completed and copies of all relevant certificates are placed on file. I noted that the training schedules are no longer up to date and some have nothing entered on them, despite the staff member having attended training. The training matrix I was given by the Manager was also out of date, as this was dated May 2006. This also contained training details of staff who have left the home. I therefore examined fourteen members of staff’s training certificates, which show that some staff still require mandatory or core training sessions. Staff have still not attended First Aid, Manual Handling, Food Hygiene, Protection of Vulnerable Adults or Challenging Behaviour training (the home currently uses the NAPPI system). Two staff members still have no record of having attended any training since their employment commenced. The training schedule supplied to me by the Manager shows that a number of training opportunities are planned for staff up to April 2007. This includes both mandatory and specialist training courses. This must be completed 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. DS0000040658.V320062.R01.S.doc Version 5.2 Page 27 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 poor. This judgement has been made using available evidence including a visit to this service. The leadership of the staff team within the home is inconsistent and needs to be improved. This would provide an improved support network for the service users and the staff team. The management systems and practices in place must be used consistently and be clearly communicated throughout the team to ensure understanding. This will help develop the quality of the service provided to the service users. The roles, responsibilities and accountabilities of each level of staffing should be clarified. This would help to ensure an effective and accountable management of the service for each service user. Organisational monitoring and support must remain robust. This will help to promote a competent and accountable service for all stakeholders. DS0000040658.V320062.R01.S.doc Version 5.2 Page 28 There are risks to the health and safety of the service users due to lack of consistency, insufficient staff training, awareness and monitoring. EVIDENCE: The Registered Manager returned to work in August 2006, following a period of sick leave. The Manager told me that they had been kept informed of the developments and improvements within the service during their absence through discussions with the Residential Services Manager and the Deputy Manager. The current management team now consists of the Manager, Deputy Manager and two Senior Support Workers. During my last inspection of this service, in June 2006, the Deputy Manager and Seniors were providing strong leadership and had made considerable progress in addressing issues raised during the previous inspection process. A number of examples such as care planning, review processes, staff training and supervision had all been subject to review and improvement. Discussions with staff members and examination of records provide evidence however that these improvements have neither been sustained nor built upon. Many of the improved systems and structures, such as health and safety records, are no longer being used consistently and the reasons remain unclear. The current management team does not appear to be as cohesive as it was in June and there is now certainly a lack of clear leadership within the service. The Support Workers I spoke with raised these issues with me during my visit and their comments are reflected earlier within this report. Discussions with the Manager, Deputy Manager and one Senior Support Worker also appear to confirm the management team is not functioning effectively. Whilst I could not ascertain the precise reasons for this, it is apparent that there is insufficient clarity in the roles and responsibilities of each member of the management team and also communication appears to be poor at times. I note that despite plans for the current management team to meet weekly, there is only one Management Team Meeting recorded on 16/10/06. The comments from members of the management team appear to confirm the views of the Support Workers, for example ‘I am not sure of my responsibilities’, ‘I find it difficult to communicate’ and ‘we need clear leadership, everyone is seeking it’. There are also examples since the Manager’s return that their comments regarding decisions/plans made between DS0000040658.V320062.R01.S.doc Version 5.2 Page 29 service users and staff, holiday plans for example, have left staff feeling undermined or not valued and this has affected their confidence and morale. Whilst I accept that staff vacancies and shortages due to staff sickness inevitably affect the level of service and the morale within the team, this appears to be only one factor in the outcomes of this inspection visit. These issues which prevail within the staff team must be taken seriously and be resolved as they inevitably have an effect on the service provided to all of the service users who live in the home. The registered provider’s representative makes regular visits to the unit, and produces a comprehensive report of his findings, which is sent to the Commission on a monthly basis. I note that within the report dated 17/10/06 there were some anxieties noted regarding the confidence both within the team and improvements within the home. The report dated 23/11/06 refers to concerns with the direction and management of the home. These reports also provide an action plan to address issues, but remedial action does not always appear to be taken within the home. 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. I examined the Fire Log during my visit. Fire drills, fire checks and training for all staff have again become irregular and are not in line with the recommended practice as detailed in the Avon Fire Log. During the last twenty weeks, nine weekly fire checks have been missed. There is no record of the emergency lighting being tested in August or September 2006. There is only one fire drill noted, on 1/06/06, although no staff are named as taking part, only ‘staff team’. Also, this drill was during the day and therefore there is no record that night staff have taken part in a recent fire drill. It is essential that all staff and service users take part in regular fire drills. All fire detection/fighting equipment must be checked regularly. The recommended frequencies are stated in the Avon Fire Log. A clear record of each drill and check must then be maintained and be made available for inspection. There is still no current Fire Risk Assessment in place and this must be developed in line with the general improvements in the home’s risk assessment processes. A generic risk assessment policy has been developed and there was evidence during my last visit that risks assessments for all safe working practices were being implemented, reviewed or updated. There appears to have been limited progress in this area as there are only five current generic Risk Assessments in DS0000040658.V320062.R01.S.doc Version 5.2 Page 30 place, implemented in May 2006, which do not appear to reflect all safe working practices within the home. This process must be completed as soon as possible. DS0000040658.V320062.R01.S.doc Version 5.2 Page 31 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 1 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 2 28 3 29 X 30 3 STAFFING Standard No Score 31 2 32 2 33 2 34 X 35 2 36 2 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 2 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 1 1 X X 1 1 2 DS0000040658.V320062.R01.S.doc Version 5.2 Page 32 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 All care plans must be reviewed and updated. A copy of care plans to be given to service users or their relatives. (This requirement is repeated from the last two inspection reports) 2. YA20 13 (2) Medication administration must be improved within the home to ensure the welfare and safety of service users. All staff must be provided with training in the Protection of Vulnerable Adults. (This requirement is repeated from the last two 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 DS0000040658.V320062.R01.S.doc Version 5.2 Page 33 Timescale for action 16/02/07 16/11/06 3. YA23 12 13(6) 16/04/07 16/03/07 inspection report) 5. YA23 13(7) Improve Behavioural Management Strategies and associated Risk Assessments to ensure the safety and welfare of service users and staff. (This requirement is repeated from the last two inspection reports) 6. YA27 23(2)(b) Replace the flooring in the shower room to restore the use of this facility for service users. 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 at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. Staffing levels to be reviewed to ensure service users opportunities are not unnecessarily limited. (This requirement is repeated from the last two inspection reports) 8. 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 DS0000040658.V320062.R01.S.doc Version 5.2 Page 34 16/03/07 16/01/07 7. YA33 18(1)(a) 16/11/06 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 inspection report) 9. YA36 18(2) a) Ensure all staff are supervised on a regular basis. b) Ensure a clear record of such supervision is maintained and made available for inspection. 10. YA38 18 19 Develop, support and maintain a management team who can supervise, motivate and lead by example. 16/04/07 16/11/06 16/11/06 11 YA42 13(4) Risk assessments on all safe working topics to be completed and be subject to regular review. 16/12/06 (This requirement is repeated from the last two inspection reports) 12. 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 inspection report) 16/11/06 13. YA42 23(4) Fire safety checks must be conducted at frequencies stipulated by the Fire Brigade. 16/11/06 DS0000040658.V320062.R01.S.doc Version 5.2 Page 35 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. DS0000040658.V320062.R01.S.doc Version 5.2 Page 36 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 DS0000040658.V320062.R01.S.doc Version 5.2 Page 37 - 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. 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