Inspection on 14/06/07 for Gardens Lane 32-34

This inspection was carried out on 14th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Gardens Lane 32-34 12/10/09

Gardens Lane 32-34 01/02/06

Gardens Lane 32-34 07/10/05

Gardens Lane 32-34 09/02/05

Gardens Lane 32-34 31/08/04

Gardens Lane 32-34 22/05/03

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

CARE HOME ADULTS 18-65 Gardens Lane 32-34 32 - 34 Gardens Lane, Rear Of Health Centre Conisbrough Doncaster DN12 3JX Lead Inspector Nadia Jejna Key Unannounced Inspection 14th June 2007 11:00 Gardens Lane 32-34 DS0000007988.V330718.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 Gardens Lane 32-34 DS0000007988.V330718.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. Gardens Lane 32-34 DS0000007988.V330718.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gardens Lane 32-34 Address 32 - 34 Gardens Lane, Rear Of Health Centre Conisbrough Doncaster DN12 3JX 01709 770322 01709 863036 gardenslane34@btinternet.com none South Yorkshire Housing Association 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) Mr Bryan Carr Care Home 12 Category(ies) of Learning disability (12), Learning disability over registration, with number 65 years of age (12) of places Gardens Lane 32-34 DS0000007988.V330718.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Five named service users over the age of 65 can remain at the home One specific service user over the age of 65, named on variation dated 8th August 2005, may reside at the home. 1st February 2006 Date of last inspection Brief Description of the Service: Nos. 32 & 34 Gardens Lane provide care for up to twelve adult service users of either gender with learning disabilities. Six people live at No.32 Gardens Lane and a further six at No.34. Both properties are purpose built bungalows with the space, facilities and equipment to accommodate people with physical disabilities including wheelchair users. The home has two adapted minibuses that enable access to the wider community. The accommodation is located in Conisborough, a former mining village close to Doncaster. Doncaster main town is about 4 miles away and Conisborough has local facilities such as shops, libraries and health and community centres close by. People enjoy a range of day care provision including access to a local social centre and social education facilities at St Catherine’s Hospital during the working week, Monday to Friday. Annual holidays, regular outings and social events are provided for everyone. The service is provided by a partnership between South Yorkshire Housing Association and Doncaster Healthcare Trust. South Yorkshire Housing Association own and operate the service with Doncaster Healthcare Trust providing the staff. This partnership provides and operates three other such schemes in the Doncaster area Information about the services provided are available in the ‘Information Pack’ that contains the Statement of Purpose and Service User Guide. Some of the information has been done in easy read picture format. The manager is looking at ways of making all the information reader friendly. At the time of writing this report the weekly charges for care and accommodation are £351.92. This information was supplied in the pre inspection questionnaire in March 2007. Gardens Lane 32-34 DS0000007988.V330718.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One visit was made on 6th June 2007. The home did not know that this inspection was going to happen. Feedback was given to the manager and the person in charge during and at the end of the visit. The purpose of the visit was to make sure the home was being managed for the benefit and well being of the people living there. Before visiting the home information was asked for from the manager in the pre inspection questionnaire (PIQ). This asks about what policies and procedures are in place and when they were last reviewed, when maintenance and safety checks were carried out and by who, menus used, staff details and training provided. Comment cards were sent to the home to be given to people living in the home, their relatives, other visitors and staff to find out what their views of the home were. The views of healthcare professionals who visit the home were also asked for. At the time of writing this report three staff, four healthcare professionals and five responses from people living in the home had been returned. Because people living in the home have some form of learning disability they had been helped by staff or relatives to complete their responses. In order to find out how well staff knew people care plans were looked at during the visit and people were spoken to. Interactions between staff and people living in the home were observed. Other records in the home were looked at such as staff files and complaints records. What the service does well: Care and support is provided to people in a home that is clean, tidy and well maintained. The bungalows are comfortably furnished and all areas of the buildings and gardens are accessible to people of all abilities, including people using wheelchairs. Aids and adaptations to help people with physical disabilities lead a normal life have been provided, for example hand and grab rails in toilets and walk in/wheel in showers. Gardens Lane 32-34 DS0000007988.V330718.R01.S.doc Version 5.2 Page 6 The home has a friendly, welcoming atmosphere. The home is run and managed as a ‘family’ home and everybody does things together, from eating meals and watching TV to going out and about in the homes minibuses. People living in the home have lots of opportunities for personal development, to be part of the local community and take part in varied social and leisure activities. They said that the staff are caring and helpful, they enjoy the meals and like going out to eat or getting a ‘take away’. They also said that they get the care and support that they needed and if they had a problem staff would listen to them and provide support as needed. People’s needs are assessed before they move into the home so that they and the provider can be sure they will be met. Detailed care and support plans are written with the individuals wherever possible. These provide staff with guidance about the person’s needs and how to meet them. The staff team are trained and competent and use these skills to help people maintain their independence and lead a socially active and fulfilled life. They work closely with healthcare professionals to look after people’s health care needs. What has improved since the last inspection? What they could do better: The inspection has highlighted that there are issues around the contracting information between the provider and people living in the home. People are routinely paying to have their own bedrooms redecorated and refurnished when it is the provider’s responsibility under the Care Homes Regulations 2001. Steps must be taken to make sure that if people living in the home want to pay to have their rooms redecorated and refurnished clear agreements between them and the provider are in place. If the individual has any communication difficulties, their relatives or an advocate must be involved. This is to make sure that people living in the home are not being used to pay for or subsidise the providers decorating and refurbishment costs. The systems used for dealing with peoples medications when they go to day centres or on holiday need to be changed to make sure that the risk of error is reduced. Gardens Lane 32-34 DS0000007988.V330718.R01.S.doc Version 5.2 Page 7 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. Gardens Lane 32-34 DS0000007988.V330718.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 Gardens Lane 32-34 DS0000007988.V330718.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, 2, 4 and 5. People who use the service experience good quality outcomes in this area. We have made this judgment using a range of evidence including a visit to the service. People have access to enough information to decide if the home will be suitable for them and their needs are identified before they move in to make sure that they can be met by the home. Because there are no agreements in place between the home and people living there about redecorating and refurbishing their rooms there is a risk that they are being used to pay for something that is the provider’s responsibility. EVIDENCE: The home is owned by South Yorkshire Housing Association (SYHA), and people living in the home have ‘tenancy or licence agreements’ in place between them and the SYHA. Care and support is provided by NHS Trust staff under a separate contract with SYHA. Gardens Lane 32-34 DS0000007988.V330718.R01.S.doc Version 5.2 Page 10 People are told about the services provided in the home in the ‘Information pack’. Some of the information has been produced in ‘easy read’ and picture format so that it can be easily understood. The manager said he was looking at providing all the information in this way. If people have problems reading staff will read it to them explaining it and making sure that they understand. The Statement of Purpose contains the information needed about the services provided by SYHA but would benefit from being revised to make it more ‘reader friendly’ and show the changes in the staff team and how the increasing age and needs of people living in the home are being met. The information provided to tenants and the tenancy/licence agreements set out the following: • The person’s rights and responsibilities as an occupant. • The SYHA’s responsibilities as owners of the home • The conditions under which the licence can be ended. • The charges made for accommodation. If an individual is self-funding a written agreement will be made about how much and how often fees are to be paid. • That the premises are furnished and SYHA will keep the furniture and fittings and decoration of the house in good state of repair. A new person had come to live at the home recently and staff talked about waiting for some of their personal money to be released so that it could be used to decorate and refurnish their room. Staff said that this was usual and that people had paid for their rooms to be redecorated, bought their own furniture, curtains, bed linens and towels. This practice is not in line with the information set out in the information leaflets and tenancy agreements or with the provider’s responsibility under the Care Home Regulations 2001. These state that the provider must make sure people have in their rooms’ adequate furniture, bedding and other furnishings including curtains and floor coverings. The manager said that people living in the home have chosen to pay for this in the past so that they can have more choice and input into how their rooms are decorated and furnished. The files seen did not contain any agreements between people living in the home (or their relatives and or advocates) and SYHA. The care file for the most recent admission to the home showed that full and detailed assessments of their needs had been carried out by social services and the health authority. It was very clear that a multi disciplinary approach had been followed with the person and their needs being at the centre of the process. The person also visited the home in a series of planned trial visits starting with half a day and building up to weekend stays. This was so they could meet other people living in the home, and the staff, and be involved with deciding if it would be suitable for them. Gardens Lane 32-34 DS0000007988.V330718.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, 8 and 9. People who use the service experience excellent quality outcomes in this area. We have made this judgment using a range of evidence including a visit to the service. People’ s assessed and changing needs are reflected in their individual plans and they can make decisions about their daily lives. EVIDENCE: Each person living in the home has a care plan that provides staff with guidance about their needs and how to meet them. During the visit three care plans were looked at. They contained an individual personal profile and an assessment of needs. They were very detailed and covered all areas of personal, health and social care needs. Information about how to maintain safety and promote independence was seen. The plans provided a pen picture of the individual’s preferred daily routine and their preferred method of communication. For example for one person who could not talk clearly there was information about what different sounds, gestures and movements mean. Gardens Lane 32-34 DS0000007988.V330718.R01.S.doc Version 5.2 Page 12 For the most recent person to come and live at the home there was clear information about how the links with the Care Programme Approach team had been kept, and their advice followed, in helping the person to settle in the home and mix with other people. It was seen that these systems were working because the person was very settled and got on well with staff and other people. Because this person has no family an advocate has been appointed to help and support them with any decisions they might need to make. Wherever possible people are involved with their care plans and any review meetings that are held. They are supported by key workers who will explain changes and help them to make their own decisions about their daily lives and routines. During the visit staff were seen asking people about where they wanted to spend their time and what they wanted to do. It was clear they had a good understanding of individuals needs, preferences, likes and dislikes and that good relationships had developed. Information from people living in the home said that the staff were very helpful in all areas of care and support. One said ‘I like the staff’. People living in the home are not able to manage their own finances. The manager acts appointee for ten of the people and has done since the home opened in 1991. All benefits are paid into individual building society accounts. Every month the manager receives an invoice from the council about individual’s contributions towards paying their care home fees and arranges for cheques from the appropriate accounts, which are sent to the council. Clear records are kept. If people want money to spend on personal items the manager will withdraw money from the accounts and hold it in safe keeping for them to use as and when they need it. When individuals spend their money receipts are obtained wherever possible and appropriate records are kept. Gardens Lane 32-34 DS0000007988.V330718.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 16 and 17. People who use the service experience excellent quality outcomes in this area. We have made this judgment using a range of evidence including a visit to the service. People have lots of opportunities for personal development, to be part of the local community and take part in varied social and leisure activities. EVIDENCE: The home has two mini buses, one for each bungalow, that are used to take people to day centres, work, shopping and for trips out. Staff said that there is usually at least one person on duty who can drive the bus and this gives people the freedom to go for a trip at short notice. For example one afternoon they went for a drive to Rotherham to get fish and chips from their favourite chip shop and they took them to a local country park to eat them and enjoy the nice weather and views. Information from staff and observations made during the visit showed that: • Breakfast and lunch are flexible and people choose what they want to eat. Staff offered people different choices and prepared the meals chosen. Gardens Lane 32-34 DS0000007988.V330718.R01.S.doc Version 5.2 Page 14 • • • • • The evening meal is chosen by people in turn and alternatives are available if not all want it. People living in the home are involved with compiling the weekly shopping list and choosing what they want to buy. They can go out with staff if smaller ‘top up’ shops are needed. People can help staff with meal preparation if they want to. Staff are aware of peoples dietary preferences, likes and dislikes. Records are kept of meals served. Staff sit with people and eat meals with them as part of promoting a homely, family atmosphere. They will also provide help discreetly to those people who need help and encouragement to eat. Some people go to day centres through the week and one person has regular employment. On a Wednesday most people go to the local community centre for a game of bingo and then out for their tea. Looking at lifestyle diaries, talking to staff and people who live in the home showed that they are helped to take part in a wide range of activities both in and out of the home. Three of the residents were looking forward to going on holiday to Blackpool the next day. Risk assessments were in place around going on holiday but there were no formal agreements about the funding arrangements for staff going on holiday with them. Information from people living at the home said that: • There are usually activities that they can take part in. • They enjoy the meals. One said they like it when they go out for a meal and when they get ‘take aways’. Another said if they don’t like something they can always ask for something else. Gardens Lane 32-34 DS0000007988.V330718.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. People who use the service experience good quality outcomes in this area. We have made this judgment using a range of evidence including a visit to the service. People receive care and support in the way they prefer and their physical and emotional health needs are met. The practices around secondary dispensing medication into other containers is unsafe and increases the risk of errors being made. Gardens Lane 32-34 DS0000007988.V330718.R01.S.doc Version 5.2 Page 16 EVIDENCE: Nurses work in the home and act as the person in charge most of the time. They are aware that the home is not registered to provide nursing care and that any nursing care has to be provided by the district nursing service. The home has an agreement with the district nurses about replacing dressings in an emergency and that staff who have received appropriate training can carry out healthcare related tasks, for example caring for a stomach feeding tube and checking blood sugar levels. A district nurse visited during the visit to attend to a person with delicate skin who was at risk of developing pressure sores and needed catheter care. Another person who had a stomach feeding tube fitted after illness was seen regularly by healthcare specialists, such as the dietician, in order to monitor their well being and provide support to them and staff. Trained nurses write the care plans with input from the individual involved, their relatives and staff. Support workers said that they looked at and used the plans regularly and those talked to had a very good understanding of individuals needs. The plans seen clearly detailed how an individual wanted to be supported on a daily basis. Observations throughout the visit showed that people living in the home were treated with dignity and respect. Information from other healthcare professionals who visit the home said that: • Home communicates clearly and works in partnership with them. • Always a senior member of staff to talk to. • Can see people in private. • Staff have an understanding of peoples needs. • Specialist advice given is included in the care plan. One commented ‘Garden Lane staff are always pleasant, residents appear happy and content and the home is always pleasant, clean, warm and friendly.’ Information from people living in the home said that: • They always got the care and support they need. • Staff listen and act on what they say. • They receive the medical support they need. Additional comments were that the staff are very helpful and another said ‘I can see my doctor or nurse any time, the staff will make me an appointment if I ask or when I need one.’ Gardens Lane 32-34 DS0000007988.V330718.R01.S.doc Version 5.2 Page 17 Information from the PIQ said that all staff deal with medication when they have received appropriate training. Support staff confirmed this and two new employees were waiting to receive this training. One of the nurses said that they provide staff with medication training updates annually but could not provide a date for their last medication update when asked. All staff, including trained nurses need to keep their knowledge updated especially if they are providing training and support. The provider has put policies and procedures about dealing with medications in place. After looking at these, the storage of medication and talking to the nurse in charge about how medication for people going to day centres or on holiday are dealt with, it was clear that they would benefit from being revised in line with The Royal Pharmaceutical Guidelines for the administration of medication in care homes. A copy of this was left with the nurse in charge. Examples of practices that need to be reviewed in order to protect people better are: • Staff put medication for people attending day centres are into plastic zipper pouches that are secured with a ‘tag’ that needs to be broken to give the tablets to the person. A handwritten label with the persons name and what is inside is placed in a plastic pocket on the front of the pouch. This is ‘secondary dispensing’ and is not good practice, there is a risk of the wrong medications being put in the pouches. The nurse in charge was advised to contact the supplying pharmacy and ask them to dispense these tablets in single dose containers. • When a person goes on holiday staff pop the tablets out of the monitored dosage system into another container, again this is secondary dispensing and not safe practice. • There were two brown envelopes in the medication cabinet that said they contained a tablet to be given to somebody if they needed it. These tablets had been ‘secondary dispensed’. But the instructions on the envelopes were that giving them could only be authorised by a trained nurse. Staff said if it was at night when there is often no nurse on duty, staff would have to ring round other homes in the group to talk to an ‘on call’ nurse. This practice could delay treatment being given. Gardens Lane 32-34 DS0000007988.V330718.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. People who use the service experience good quality outcomes in this area. We have made this judgment using a range of evidence including a visit to the service. People living in the home are protected from abuse and can be confident their views will be listened to and acted upon. EVIDENCE: A complaints procedure is in place. Staff make sure that people understand this and know what to do. If a complaint is made there are procedures in place for dealing with it and records would be kept. There have been no complaints made since the last inspection over twelve months ago. Information from people living in the home said that: • They knew who to talk to if they were unhappy. One said that they have a key worker they can talk to. Another said ‘I have a special interest worker and a named nurse who I can talk to.’ • They knew how to make a complaint and one said that the complaints procedure had been explained to them. Another said ‘Yes - I would tell staff and they would help me to fill in the complaints from.’ Staff said that they were aware of complaints procedure and would speak to the manager. Gardens Lane 32-34 DS0000007988.V330718.R01.S.doc Version 5.2 Page 19 Adult protection policies and procedures are in place. Staff are made aware of them during the induction training when they start work. The training organised for staff by the provider varies and depends if they are trained nurses or support workers. The training for nurses is more in depth. The provider should consider making sure all staff receive the same level of abuse awareness and adult protection training. Staff spoken to during the visit said they knew about the adult protection procedures and that they would not hesitate to report actual or suspected abuse. As detailed in a previous section the manager acts as appointee for most people living in the home. Detailed records are kept of financial transactions and people are able to access their personal money when they need to. The manager has acted as executor for somebody in the past and is named as executor for someone living in the home now. He was advised to look for an advocate to fulfil this role if there are no relatives because wherever possible staff in the home should not be acting as agents for people living in the home. Policies and procedures are in place around dealing with violence and aggression. Staff training is provided around dealing with challenging behaviour and it is based around preventing intervention and deescalating the situation. There have been no incidents where staff have needed to use restraint since the last inspection over twelve months ago. Gardens Lane 32-34 DS0000007988.V330718.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27, 28, 29 and 30. People who use the service experience excellent quality outcomes in this area. We have made this judgment using a range of evidence including a visit to the service. People live in a clean, comfortable and well maintained home that is suitable for their needs. EVIDENCE: Both bungalows were clean, tidy, well maintained and nicely decorated. They each have their own style and have been decorated to suit peoples choices and preferences. There are comfortable communal areas with different styles of chairs and sofas for people to use. There are enclosed garden areas for each bungalow that are easily accessible to people of all abilities. When the weather permits people can sit outside enjoying the views, look at the fishponds and have a barbecue. The provider has taken into account the fact that people living in the home are getting older and might have problems with mobility and using the toilet and bathing facilities. A bathroom in each bungalow has been fitted with an electric bath hoist and a wheel in shower. Gardens Lane 32-34 DS0000007988.V330718.R01.S.doc Version 5.2 Page 21 People are accommodated in single rooms. These are decorated and furnished in a style of their own choosing which includes the floor coverings, curtains, bedding and towels that they use. It has been discussed already in this report that people have been paying for this themselves when it is the providers responsibility to decorate and furnish rooms and to provide bed linen and towels. If people choose to pay for these things then there must be clear written agreements in place between them and the provider. The laundry was clean and tidy and the washing machine has a sluice cycle to help with infection control. But neither bungalow has a sluice facility for emptying and cleaning urinals and commode pans. Staff said they emptied commodes down toilets and then disinfected with supermarket bought products. The nurse in charge was advised to contact the infection control nurse for advice on cleaning and disinfecting these items safely. The provider should look at providing sluicing facilities. The PIQ said that the last fire safety officers report was in November 2006 and that all recommended works have been done. Gardens Lane 32-34 DS0000007988.V330718.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36. People who use the service experience good quality outcomes in this area. We have made this judgment using a range of evidence including a visit to the service. There are enough appropriately trained and competent staff on duty to meet peoples needs. Their skills could be developed further around meeting the needs of older people. EVIDENCE: Staffing levels in the home are appropriate to meet the needs of people living there. There are three staff on duty in each bungalow between the hours of 7 in the morning and 9 in the evening and at night there is one waking carer and one sleep in carer. Staff said that if all allocated staff were on duty this was enough to do all that they needed to do. In addition to their supporting and caring role staff also do the cleaning, laundry and prepare meals. Information from people living at the home said that: • Staff are available when they need them. • Staff always make time for them. • The staff are good. Gardens Lane 32-34 DS0000007988.V330718.R01.S.doc Version 5.2 Page 23 Information from staff working at the home said that: • They received good support from the staff team and manager. • Good team working and support made it a ‘pleasure to come to work.’ • They received regular 1 to 1 supervisions and annual appraisals. • There had been some problems with staffing due to sickness and people leaving BUT personal care and support to residents had not been affected. • They received annual updates for training around food hygiene, moving and handling, basic life support and fire safety. • A carer who started working at the home four months ago said they had done LDAF (Learning Disabilities Award Framework) training, induction training and enrolled on NVQ (National Vocational Qualification) training at level 2. Staff training is provided by the NHS Trust. The homes training coordinator puts in a request for staff training and dates will be provided when places for different courses are allocated. The Trust has put together a list of what they consider to be required training for staff. This includes: • Trust induction training over two days that includes sessions on health and safety, infection control as well as guidance for employees about the Trust’s policies and procedures. • LDAF (Learning Disabilities Award Framework) training that includes abuse, managing violence and aggression, moving and handling, learning disabilities, communication and basic life support. This programme of training is being matched to Skills for Care common induction standards. • Fire marshal training, which will be updated in full every two years and refreshed annually. All staff are involved with fire drills every six months. • Annual updates on moving and handling training. The training coordinator can request other training courses for staff. For example other courses requested have included using makaton, signing and swallowing difficulties. The basic life support training does not include first aid, and it was recommended that all staff receive this training. Other subjects that should be considered are training about epilepsy for all staff. As people are in the home are getting older and developing other age related conditions appropriate training should be made available such as dementia. Staff recruitment records are held centrally by the NHS Trust and could not be looked at on this occasion. The manager said he was starting to complete forms produced by CSCI that would show that all required pre employment checks had been carried out. These will be reviewed at the next inspection. Gardens Lane 32-34 DS0000007988.V330718.R01.S.doc Version 5.2 Page 24 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, 39, 40 and 42. People who use the service experience excellent quality outcomes in this area. We have made this judgment using a range of evidence including a visit to the service. The home is run and managed in the best interests of people living there. Their health, safety and well being is promoted and protected. EVIDENCE: The manager is a qualified nurse and has been managing the home since it opened in 1991. He has many years experience of working with people with learning disabilities and managing a staff team. He said that he has an open management style. He makes sure that staff are aware of their responsibilities and are involved with most aspects of running the home. Regular staff meetings are held which link into outcomes for people living in the home as well as other management issues. Alongside these there are monthly ‘tenants meetings’ where staff will ask people individually how things are and if they have any issues or ideas for changes. Gardens Lane 32-34 DS0000007988.V330718.R01.S.doc Version 5.2 Page 25 Information from staff said that: • It was a good staff team and they worked well together. • The manager was easy to approach and very supportive. • They enjoyed working as part of a team that helps people to achieve and fulfil their potential and where peoples choices are always taken into account. • The home was run as if it was a ‘family’ home and everybody ‘did things’ together, eating meals, watching TV, going out and about. • Staff said they feel valued and can contribute to staff meetings and make suggestions for changes. One of the support workers is a representative on the providers ‘Quality Board for Community Homes’. They said that they look for ways of improving service delivery. This includes doing an annual survey of people’s views. The questionnaires are easy to read and use symbols to show if a person is happy or unhappy with services provided. The completed questionnaires are kept in individual’s files. The results of these surveys should be collated and made available to interested people. The support worker said they would do this. The provider also produces a newsletter about the services it provides. Staff in the homes are going to be involved with producing this and it will include items about the different homes, the people living in them and what they do. Representatives from SYHA and the NHS Trust visit the home regularly to carry out monitoring visits looking at how the home is being run and managed. Reports are made and copies sent to the CSCI. The PIQ said that appropriate policies and procedures are in place to provide guidance to staff. Copies are kept in each bungalow and staff said they knew where to find them. The PIQ said that all appropriate health and safety checks are carried out, including the servicing and maintenance of equipment such as hoists and electrical and gas appliances. Gardens Lane 32-34 DS0000007988.V330718.R01.S.doc Version 5.2 Page 26 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 3 3 X 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 4 25 3 26 3 27 3 28 4 29 3 30 2 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 3 3 X LIFESTYLES Standard No Score 11 4 12 4 13 4 14 4 15 X 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 2 X 4 4 3 3 X 3 X Gardens Lane 32-34 DS0000007988.V330718.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA5 Regulation Requirement Timescale for action 30/07/07 16(c) The provider must make sure 23(2)(b)(d) that rooms occupied by people are, maintained, redecorated and equipped with adequate furniture, bedding and other furnishings, including curtains and floor coverings as set out in their information for residents document dated January 2006. If people choose to redecorate and refurnish their own rooms written agreements must be in place to demonstrate this. If the person has communication difficulties their relatives or an advocate must be part of this process. 13(2) In order to make sure that people are protected and safe systems used when dealing with medications the provider must revise the policies and procedures in line with The Royal Pharmaceutical Guidelines for the administration of medicines in care homes. The supplying pharmacist must be contacted and asked to 2. YA20 30/08/07 Gardens Lane 32-34 DS0000007988.V330718.R01.S.doc Version 5.2 Page 28 supply medications for holidays and day centres in appropriately labelled containers. All staff must receive up to date training around dealing with medication safely. 3. YA23 YA7 20(3) The provider must make sure that as far as practicable staff in the home do not act as agent or executor for people living in the home. If there are no relatives then independent advocates must be considered. 30/08/07 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 YA1 Good Practice Recommendations In order to be sure that people have access to information about services provided, the Statement of Purpose should be revised to include changes in the staff team and how the increasing age and needs of people living in the home are being met. All information should be available in a ‘reader friendly’ format and using easy read text and pictures should be considered. In order to protect people living in the home and staff from the risk of cross infection the registered provider should provide sluicing facilities for cleaning commodes and urinals. The manager should make contact with the infection control nurse for advice on cleaning and disinfecting these items safely. In order to protect people living in the home the manager should make sure that the records evidencing that staff have been recruited properly, and all pre employment checks carried out are fully completed and available for inspection. DS0000007988.V330718.R01.S.doc Version 5.2 Page 29 2. YA30 3. YA34 Gardens Lane 32-34 4. YA35 The provider should make sure that staff receive first aid training and other training courses relevant to the needs and increasing age of people living in the home. The results of quality assurance surveys should be collated and the results made available to interested people. 5. YA39 Gardens Lane 32-34 DS0000007988.V330718.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR 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 Gardens Lane 32-34 DS0000007988.V330718.R01.S.doc Version 5.2 Page 31 - 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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