Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 06/02/06 for Gallaudet Unit

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

This inspection was carried out on 6th February 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 19 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 users to enable them to lead fulfilling lives. Two service users spoken with liked living at the home and were happy with the support they received.

What has improved since the last inspection?

The morale and dynamics within the staff team has improved. This has led to a more consistent support network for service users.

What the care home could do better:

A copy of the service users contract between the RNID and the service user must be made available to the manager.The Statement of Purpose must be updated to 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 environment requires modernisation and redecoration in several areas to provide a homely environment for service users. A self-auditing tool for measuring the home`s success in achieving the aims and objectives has been introduced. However the outcomes must be evidence based to ensure the quality of the service provided is accurately measured. All staff must be trained in the Protection of Vulnerable Adults and be able to demonstrate their understanding of indicators, forms and responses to actual or suspected abuse. This is crucial to ensuring the safety and welfare of service users. All staff must be trained in responding to challenging behaviour in a planned and safe manner. This will ensure the safety or service users and staff. All staff must receive formal induction training within the timescales defined by the organisation. This will ensure staff are provided with the necessary skills to support service users. Staff must be provided with any additional specialist training to enable them to provide appropriate and consistent levels of support to service users. A staff-training matrix should be introduced and maintained in good order. This will ensure all staff training can be effectively monitored. All staff must be supervised on a regular basis and a clear, signed record of each meeting must be maintained. This will ensure all staff are supported to provide support the service users. 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 Risk Assessment processes must be reviewed and improved. This will ensure safe working practices are present within the home to ensure the welfare of service users and staff. Clear reactive strategies must be put in place 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.Gallaudet Unit DS0000040658.V281743.R01.S.doc Version 5.1 Page 7Incidents 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. The Commission must be notified of any incident requiring the use of any restrictive or physical intervention. This will ensure a safe and accountable system is in place for each service user. Regular fire drills and training still need to be implemented. Weekly tests of fire equipment need to be maintained. This will promote the safety and welfare of service users and staff. Organisational monitoring and support of the service needs to improve. This will help promote the safety of service users, improve service delivery and support the management team within the home. The management team and senior support workers 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 introduced and used consistently. The home should review its progress in providing service users with information in a format which is accessible to them.

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 6 and 7th February 2006 09.30 th Gallaudet Unit DS0000040658.V281743.R01.S.doc Version 5.1 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.V281743.R01.S.doc Version 5.1 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.V281743.R01.S.doc Version 5.1 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.V281743.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 8 persons aged 18 to 64, requiring personal care. 2nd August 2005 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. . Gallaudet Unit DS0000040658.V281743.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and carried out over two days. The inspector gathered information for this report from discussions with the Registered Manager, one senior support worker, four support workers, two service users and observation of interaction and support between staff and all eight service users. Care plans and associated records were examined along with the Statement of Purpose, Quality Assurance Review, staffing, medication, complaints and health and safety records. The inspector was also provided with a tour of all communal areas within the home. What the service does well: What has improved since the last inspection? What they could do better: A copy of the service users contract between the RNID and the service user must be made available to the manager. Gallaudet Unit DS0000040658.V281743.R01.S.doc Version 5.1 Page 6 The Statement of Purpose must be updated to 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 environment requires modernisation and redecoration in several areas to provide a homely environment for service users. A self-auditing tool for measuring the home’s success in achieving the aims and objectives has been introduced. However the outcomes must be evidence based to ensure the quality of the service provided is accurately measured. All staff must be trained in the Protection of Vulnerable Adults and be able to demonstrate their understanding of indicators, forms and responses to actual or suspected abuse. This is crucial to ensuring the safety and welfare of service users. All staff must be trained in responding to challenging behaviour in a planned and safe manner. This will ensure the safety or service users and staff. All staff must receive formal induction training within the timescales defined by the organisation. This will ensure staff are provided with the necessary skills to support service users. Staff must be provided with any additional specialist training to enable them to provide appropriate and consistent levels of support to service users. A staff-training matrix should be introduced and maintained in good order. This will ensure all staff training can be effectively monitored. All staff must be supervised on a regular basis and a clear, signed record of each meeting must be maintained. This will ensure all staff are supported to provide support the service users. 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 Risk Assessment processes must be reviewed and improved. This will ensure safe working practices are present within the home to ensure the welfare of service users and staff. Clear reactive strategies must be put in place 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. Gallaudet Unit DS0000040658.V281743.R01.S.doc Version 5.1 Page 7 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. The Commission must be notified of any incident requiring the use of any restrictive or physical intervention. This will ensure a safe and accountable system is in place for each service user. Regular fire drills and training still need to be implemented. Weekly tests of fire equipment need to be maintained. This will promote the safety and welfare of service users and staff. Organisational monitoring and support of the service needs to improve. This will help promote the safety of service users, improve service delivery and support the management team within the home. The management team and senior support workers 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 introduced and used consistently. The home should review its progress in providing service users with information in a format which is accessible to them. 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.V281743.R01.S.doc Version 5.1 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.V281743.R01.S.doc Version 5.1 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, 3 and 5. The home has a Statement of Purpose available. This must be updated and amended to ensure it provides accurate information for all service users. There are no contracts in place between the RNID and Funding Authorities, as there need to be. This remains an outstanding requirement from previous inspections but because compliance with this requirement is outside the control of the manager it is being raised with the Commission for Social Care Inspection’s Provider Relationship Manager as a national issue. EVIDENCE: The Statement of Purpose is detailed but still needs to include the number and size of all rooms. The document should also advise the reader on whether or not nursing care is provided. The document is not in Braille or any other format other than written English. The inspector examined this document in detail. It is not clear that this accurately reflects the service, ethos, systems and procedures which are in place within the home. The Statement of Purpose clearly describes the training schedule, which all staff members must adhere to. It also states Support Workers are expected to Gallaudet Unit DS0000040658.V281743.R01.S.doc Version 5.1 Page 10 be qualified to NVQ Level 2/3. The evidence gathered at inspection shows inadequate staff training and none of the support worker team has a National Vocational Qualification. This document also assures the reader that the annual Quality Assurance review will incorporate the views of service users and their families. The Registered Manager confirmed to the inspector that this had not been part of the review recently carried out. It is essential the home’s Statement of Purpose should clearly reflect the service provided. It should also be used as part of the annual Quality Assurance process. This document must be reviewed and amended. Gallaudet Unit DS0000040658.V281743.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Care plans are reviewed and updated annually. Service users are supported to participate in this process. This process should be improved to ensure care plans are reviewed at least every six months. Staff provide service users with information and encourage them to make informed choices wherever possible. Specialist forms of communication assist with this process. The home should review is progress in providing information in accessible formats. The Risk Assessments process in place is designed to ensure service users welfare and safety. This system must be improved to ensure regular reviews and updates are carried out and communicated to the staff team. EVIDENCE: Three care plans were examined in detail by the inspector and these provided sufficient information on the areas of support each person required. Gallaudet Unit DS0000040658.V281743.R01.S.doc Version 5.1 Page 12 Regular annual reviews are held, which include service users, their families, Social Workers and Keyworkers. These are clearly recorded and the outcomes used to update individual care plans. It was not clear what process is in place to ensure each care plan is reviewed at least every six months. There was no evidence to demonstrate any other review process apart form the annual multi agency review. This system must be improved to ensure all care plans be reviewed every six months or sooner if service users support needs change. During the course of the inspection the inspector observed interaction, communication and support between the staff team and all of the 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 are 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. Staff spoken with remain focused and enthusiastic in their efforts to provide a consistent and high standard of support and care to each service user. All staff agreed that the improvement in the dynamics and morale within the staff team has led to a more consistent approach in supporting the service users. They feel they encourage service users to make choices as far as their skills and abilities allow. There are person centred Risk Assessments in place for some service users, however this is not consistently provided to all service users. The inspector examined these records. Several of the Risk Assessments were out of date, as there is no clear process of them being reviewed. Some did not contain dates of when they were written, so it was not possible for the inspector to ascertain if these were current or required updating. There are no systems in place to either ensure all staff have read and understood the Risk Assessments or to ensure these are regularly reviewed. Four staff spoken with could not clearly describe the Risk Assessment process or how this related to the support of service users. This process must be improved. The home must develop a clear review process, which is then adhered to. All staff must be made aware of the Risk Assessment process and the relationship to the support provided to each service user. The home must also introduce a system to ensure all staff have read and understood each Risk Assessments and informed if these are updated or amended. This is an essential element in enabling the home to ensure the welfare and safety of the vulnerable adults who live here. Gallaudet Unit DS0000040658.V281743.R01.S.doc Version 5.1 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, 15 and 17. 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 needs to be reviewed to ensure all service users have sufficient opportunities and appropriate support to access leisure and educational facilities. A healthy, balanced and varied diet is promoted. Records are now maintained for each service user in this area. EVIDENCE: Service users have the opportunity to attend daily Educational Development Studies. Facilities available in the wider community are also used, including Gallaudet Unit DS0000040658.V281743.R01.S.doc Version 5.1 Page 14 horse riding, shopping, going for walks, going on holiday, trips to local pubs and going out for meals. One service user spoke to the inspector that he supports Bath City F.C. He attends all home matches and occasionally is supported to attend away matches. He likes to go swimming, as he is a good swimmer. He also enjoyed his holiday in the Isle of Wight and his visit to his family who live in Wales. Another service user told the inspector he supports Chelsea F.C. He likes watching football, going out for meals, playing snooker, going on holiday and going to the workshop. He has friends there and likes making things. He does woodwork and pottery. He had recently made a bird box for his sister. He visits his family regularly. Sometimes staff will drive him there or he will use the train and his family meet him at the station. He would like to move home one day and live in a flat on his own. The flats close to his present home would be ideal as he says he has friends who live there. The daily records examined did show varying levels of activities for service users. Four staff spoken with did express concern at staffing levels when there was no staff member on a mid shift. The minimum staff levels are three on an early shift and three on a late shift. On some days there is a mid shift who works across both shifts. The rota for this week confirmed that there was a mid shift on only two days out of seven. Staff spoken with confirmed that some service users require two staff to support them in the community. It is not clear therefore what opportunities they have when only three staff are on duty, as one staff member cannot be left alone in the home with the remaining service users. The staffing levels maintained within the home should therefore be reviewed 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. The menus are now planned in advance and are displayed in the kitchen area. These show a wide range of food, which provide both a healthy and balanced diet. A record is now maintained in each service users daily records of meals and snacks. Gallaudet Unit DS0000040658.V281743.R01.S.doc Version 5.1 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, 19 and 20. The care plans explain the support each service users requires in relation to their personal and health care. The record keeping for each service user must be improved. A monitored dosage system of medication for service users is in operation and this is well managed. EVIDENCE: Each service user is registered with a local GP, Dentist and other relevant professionals. There are varying levels of support from other health care professionals. The inspector found service users records extremely difficult to track, especially when trying to establish the outcomes of each appointment or how the monitoring of service users health was acted upon or used as part of the review process. Gallaudet Unit DS0000040658.V281743.R01.S.doc Version 5.1 Page 16 One service user had gained twenty pounds over a period of 4 months, however there was no evidence from the service users care plan that this information had been acted upon either as a general health or dietary issue. The was no clear evidence that all service users are being regularly weighed, having their blood pressure monitored or their pulse measured despite there being a clear recording system in place for each of these checks. Some service users are extremely vulnerable and rely on staff to identify or act upon any changes or concerns. The systems, which are in place, are therefore crucial in providing adequate levels of support for each service user to ensure their health care is promoted. The records for each service users contacts with health care professionals must be improved. These must show that staff are clearly monitoring and recording service users health care. These records must also be used to update the care plans when necessary and as part of the review process. The home uses the Boots Monitored Dosage System of medicine administration. This is well managed. The medication records show profiles of each service user, recent photograph, details of their medication, times of administration and manufactures notes on each of the prescribed medications administered within the home. The home has also obtained Boots guidance on the expiry dates on non blister packed medication and from a GP in relation to adding anti- convulsant medication to food for one service user. Gallaudet Unit DS0000040658.V281743.R01.S.doc Version 5.1 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 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 training in the Protection of Vulnerable Adults. All staff must ensure they have read and understood the RNID policy and procedure relating to adult protection. Clear reactive strategies 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 must be updated to ensure the correct details of the contact at CSCI is available to all service users. One service user had made a complaint in October 2005. This was recorded in the Regulation 26 Visit Record for that month. However on the day of inspection no record of this complaint could be located either in the complaints file or the service users own records. Following discussion with the Registered Manager, the inspector was not able to ascertain where the records were, the nature of the complaint or the Gallaudet Unit DS0000040658.V281743.R01.S.doc Version 5.1 Page 18 outcome. This complaint must be located and a copy, together with details of the investigation process and outcomes, forwarded to the Commission immediately. Complaints must be 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 inspection. The inspector spoke with four staff members. None had been trained in the Protection of Vulnerable Adults, which their training records confirmed, or had a good knowledge of the RNID’s own Adult Protection policy. They were therefore unsure of the indicators of abuse or what action to take if they witnessed or suspected abuse whilst on duty. All four staff members confirmed that several service users would rely on staff to identify abuse and act on their concerns. All staff must be provided with training in this area. This is to ensure the safety and welfare of service users and staff. This remains an outstanding requirement from the last inspection. The home has clear policies in place, which are designed to support service users who are distressed, or presenting behaviours which may be perceived as challenging the service provided. Some staff have received training in this area using the NAPPI system. 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 were also evident. Staff are required to complete Incident Reports for each behaviour exhibited by service users. Both care planning and recording practices are insufficient and inconsistent. There was no evidence that each method of approach is regularly reviewed. The incident reports do not provide a clear record of each incident, as they do not describe antecedents, setting conditions, interventions used, timescales or outcomes. This is inadequate and not in accordance with RNID Policy. Staff are required to perform physical interventions as part of some service users behavioural strategies. It is unclear how these can be performed consistently or safely, as a number of staff have still not received NAPPI training. The Commission has not received any notification that a physical intervention has been used, despite the records suggesting that they had. The Commission should be notified when restrictive physical interventions are used. Gallaudet Unit DS0000040658.V281743.R01.S.doc Version 5.1 Page 19 There are no Risk Assessments in place for service users who require physical intervention as part of their behavioural support plan. These are described as essential in both the RNID Policy and the Department of Health Guidance. These must be implemented immediately, communicated to all staff members and regularly reviewed. These improvements are essential, as they will provide a consistent and safe method of support for the service users and the staff team. This remains an outstanding requirement from the last inspection. Gallaudet Unit DS0000040658.V281743.R01.S.doc Version 5.1 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 and 30. Although the home was generally clean and tidy, several improvements are needed to maintain safety, comfort and provide a more homely environment for the service users. EVIDENCE: The home was generally clean and tidy on the day of inspection. The inspector did find one bin in the bathroom had urine inside it. This was removed and cleaned by staff when alerted by the inspector. The new lounge area as you enter the home has improved the environment. This area was used by three service users regularly during the inspection. The decorative order of this room however is in contrast to many other areas within the home. The bathrooms need both modernisation and redecoration. One sink unit in the one bathroom was seen to be cracked and should be replaced immediately. Plans to update and modernise all bathrooms have been submitted to the RNID for approval. The inspector concurs this work is essential. Gallaudet Unit DS0000040658.V281743.R01.S.doc Version 5.1 Page 21 The communal hall areas require redecoration and the carpeting should either be replaced or professionally cleaned. Staff spoken with agreed that these areas should be redecorated, with service users being supported to choose the decoration/colour schemes. This would provide a more homely environment for all service users. The kitchen area has padlocks fitted on several of the cupboard doors. Staff explained that this is to ensure that service users who suffer from diabetes do not have access to inappropriate food. The home should investigate alternatives. The current method of securing these doors does not provide a homely environment and also restricts access to food for all service users. If food is still to be locked away from some service users, this must be supported by a Risk Assessment. Staff spoken with explained the large conservatory area outside the office had plans to be developed into an activity/arts and craft room. This had not occurred but staff did not know why this had not taken place. Several staff thought that this could be an extremely useful area, especially when staffing levels made it difficult to access community facilities. This area should be developed in line with the original proposals as this could provide a valuable resource for all service users and staff. Gallaudet Unit DS0000040658.V281743.R01.S.doc Version 5.1 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): 32, 33, 35 and 36. The staff team has become more cohesive and effective in supporting the service users. All staff must be provided with all core training in accordance with National Minimum Standards and RNID Policy. A clear and up to date record of all staff training must be maintained. There needs to be a clear action plan in relation to supporting staff to obtain a National Vocational Qualification. All staff must be supervised on a regular basis and a clear record maintained in their personnel files. EVIDENCE: Staff spoken with explained that there had recently been conflict within the team and staff had experienced difficulty in maintaining cordial working relationships with their colleagues, and that the key values of the service were being affected by this. Recent staff changes appear to have assisted in the improvement of both the dynamics and morale within the team. Gallaudet Unit DS0000040658.V281743.R01.S.doc Version 5.1 Page 23 Staff also confirmed to the inspector that they had not been provided with several training courses. None had completed all of the core training. One had not received any training apart from being enrolled on BSL Stage 1. The inspector viewed the training records for staff. These should contain copies of certificates from all training courses staff members had attended. Many of these files contained only two/three certificates. Some files contained no records at all. One staff member did not have a training file. None of these records showed that any member of staff had completed their core training. It is essential that staff receive all core training. This should include First Aid, Manual Handling, Food Hygiene, Fire Procedures, Protection of Vulnerable Adults and NAPPI. This should be complemented by other more specialised training to ensure all staff are provided with the appropriate skills to support each service user. The home must also implement a system to monitor the training of all staff. A training matrix format does exist but is not being used by the home. This must be brought into use immediately and be kept up to date. This will ensure that all staff training can be effectively monitored. The home does not currently not have any member of its staff team trained to NVQ Level 2/3/4. The standards expect at least 50 of the team to be trained or working towards these qualifications. There have been recent meetings to discuss NVQs. A plan must now be developed describing how staff are to be supported to gain these qualifications, including the anticipated timescales and a copy supplied to the Commission. The inspector viewed the supervision records for eight staff members. These records showed that staff are not being supervised regularly. Five members of staff have been supervised once in the last 12 months and three have been supervised twice. Several supervision notes were not explicit and the inspector could not ascertain what discussions had taken place or what outcomes had been agreed upon. Also several records had not been signed by either the supervisor or supervisee and others not dated. Staff must be provided with supervision on a regular basis. These meetings must be clearly recorded and signed by both supervisor and supervisee to agree that the record is accurate and the outcomes agreed. Seven staff had appraisal meetings within the last year. All objectives agreed upon involved additional training for each staff member. The comments above regarding inadequate training opportunities show that the outcomes from these appraisals were not being acted upon. Gallaudet Unit DS0000040658.V281743.R01.S.doc Version 5.1 Page 24 Gallaudet Unit DS0000040658.V281743.R01.S.doc Version 5.1 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 and 42. The leadership of the staff team both within the home and from the organisation remains 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 require significant improvement. These must also be clearly communicated throughout the team to ensure understanding. This will help develop the quality of the service provided to the service users. An annual Quality Assurance audit of the service is now conducted. This process must be improved to ensure the views of service users and other stakeholders are reflected and that the conclusions in the report are evidence based. There are risks to the health and safety of the service users due to lack of consistency, insufficient staff training and awareness and monitoring. Gallaudet Unit DS0000040658.V281743.R01.S.doc Version 5.1 Page 26 EVIDENCE: The manager of the service has been absent from work for several months due to illness. The Deputy manager was asked to manage the home during this time, supported by a senior support worker. Both of these staff members have since left the RNID. During this time several staff commented to the inspector that the deputy manager and senior support worker did not have an effective or professional working relationship. Some staff found them difficult to approach and others felt intimidated by them. This caused considerable conflict within the team, reduced morale and affected the support provided to service users. The recent changes in the staff team have led to improvement in this area and staff morale and team working has been re-established. It is not clear from discussions with the manager or staff team members if any additional support was provided by the organisation during this time. The managers absence was not reported to the Commission as required by the Regulations. Since her return to work the manager has focused on issues remaining within the staff team and has tried to recruit both a Deputy Manager and two senior support workers. The senior support worker posts are now filled, but the Deputy Manager post remains vacant. The manager accepts that the systems and structures are not effective or efficient. They do not provide accurate or reliable information to ensure that the home can be well managed. For example the manager told the inspector that she relies on staff to tell her what training they have attended. A training matrix is not in use and staff training records are incomplete. Also, both her previous deputy and senior support worker had told her they were supervising staff, but there were no checks made or any system of recording implemented which the manager could use to track that these meetings were taking place. The manager must implement effective systems to ensure that the service can be well managed and these must be maintained. This will provide a more consistent service for all service users and support for the staff team. A quality audit of the service has now been conducted and a copy of the report provided to the inspector on the second day of the inspection. It was not clear to the inspector who provided information to form this report. The manager Gallaudet Unit DS0000040658.V281743.R01.S.doc Version 5.1 Page 27 explained that this is a self-auditing tool, which she completes and then passes to her line manager for comment/agreement. It does not appear that service users views are central to this process as the manager confirmed they do not contribute despite the home’s Statement of Purpose confirming that they do. The inspector sampled some of the audit’s findings. The conclusions and the scoring of standards do not appear to be based on any evidence. For example Standard 35, (staff) Training and Development; the home is scored as d), ‘comprehensively demonstrated’, in all but one area. The records of all staff training however show major weaknesses in the training and development opportunities for staff. Standard 32 (staff) Qualities and Qualifications; the home is scored as c) ‘demonstrated to a large extent, but some gaps or minor weaknesses’ where there is no evidence staff do meet national occupational standard levels, hold NVQs or can demonstrate knowledge and skills in the stated ‘required subjects’. Standard 23 (service users) Protection; 9 out of 14 elements scored d) and the remaining 5 c) whereas the evidence gathered at inspection again demonstrates major shortfalls in the minimum standards expected. The audit process must be improved. It should represent the views of service users and other stakeholders. Their contribution to this process should be recorded and incorporated into the report. The conclusions noted should be accurate and based on evidence, which can be substantiated. A generic risk assessment policy has been developed, however there was no evidence that risks assessment for all safe working practices have been carried out as required at the last inspection. Several of the Risk Assessments located were out of date as they did have any evidence of being reviewed. Others were not signed or dated at all. It was not evident how staff are made aware of Risk Assessments and discussions between the inspector and staff members did cause concern as several staff did not understand the Risk Assessment process or what areas the generic assessments covered. All staff must be made aware of this process and how this helps to ensure the welfare and safety of everyone in the home. Fire drills, fire checks and training for all staff remain irregular and are not in line with the recommended practice as detailed in the Avon Fire Log. This is an outstanding requirement from the last inspection. 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. Gallaudet Unit DS0000040658.V281743.R01.S.doc Version 5.1 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 2 4 X 5 2 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 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 2 34 X 35 1 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 1 X LIFESTYLES Standard No Score 11 2 12 2 13 3 14 2 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 3 X 2 1 1 X X 1 X Gallaudet Unit DS0000040658.V281743.R01.S.doc Version 5.1 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 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. 2. YA6 15 All care plans must be reviewed and updated. Copies of care plans to be given to service users or their relatives. All clear record of all review processes must be maintained. Staffing levels to be reviewed to ensure service users opportunities are not unnecessarily limited. All complaints made must be recorded and stored securely. Improve Behavioural Management Strategies and associated Risk Assessments to ensure the safety and welfare of DS0000040658.V281743.R01.S.doc Timescale for action 07/04/06 07/05/06 3. 4. YA6 YA33 15 18(1) 07/02/06 07/05/06 5. 6. YA22 YA23 22 13(7) 07/02/06 07/04/06 Gallaudet Unit Version 5.1 Page 30 service users and staff. 7. YA23 12 All staff must be; a) Provided with training in the Protection of Vulnerable Adults. 07/05/06 b) Conversant with the RNID Adult Protection Policy. 8. 9. 10. 11. 12. YA24 YA24 YA24 YA24 YA32 23(2) b 23(2) b 23(2) b 23(2) b 18(1) Professionally clean or replace carpeting in the communal corridor area. Redecorate the communal corridor area within the home. Replace the broken sink unit in one bathroom. Refurbish and redecorate all bathrooms. Devise a clear plan detailing how staff are to be supported to gain a National Vocational Qualification and supply this plan to the Commission. 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. a) Ensure all staff are supervised on a regular basis. b) Ensure a clear record of such supervision is maintained in their personnel file. 15. YA39 24, 12(3) The Quality Assurance audit process must be improved and outcomes evidenced. 07/05/06 07/08/06 07/03/06 07/08/06 07/05/06 13. YA35 18(1) 07/06/06 14. YA36 18(2) 07/02/06 07/02/06 Gallaudet Unit DS0000040658.V281743.R01.S.doc Version 5.1 Page 31 16. YA42 23(4) Regular fire drills & training must be implemented. Weekly tests of fire equipement to be actioned. Clear records must be maintained. Risk assessments on all safe working topics to be completed and be subject to regular review. Develop and support a management team who can supervise, motivate and lead by example. Ensure all notifiable incidents are reported to the Commission as required by the regulations. 07/02/06 17. YA42 13(4) 07/02/06 18. YA31, 33, 38 18, 19 07/05/06 19. YA42 37 07/02/06 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. 2. Refer to Standard 6 YA35 Good Practice Recommendations The development of accessible formats for service users should be reviewed by the home and a record kept as part of each care plan. A training matrix should be introduced and maintained in good order. Gallaudet Unit DS0000040658.V281743.R01.S.doc Version 5.1 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.V281743.R01.S.doc Version 5.1 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!