Inspection on 15/05/06 for Gladstone Road, 31

This inspection was carried out on 15th May 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 14 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Gladstone Road, 31 12/06/09

Gladstone Road, 31 10/07/08

Gladstone Road, 31 31/07/07

Gladstone Road, 31 14/12/05

Gladstone Road, 31 01/07/05

Gladstone Road, 31 04/03/05

Gladstone Road, 31 23/09/04

Gladstone Road, 31 01/03/04

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

CARE HOME ADULTS 18-65 Gladstone Road, 31 31 Gladstone Road Bootle Liverpool Merseyside L21 1DG Lead Inspector Ms Lorraine Farrar Unannounced Inspection 15th May 2006 10:00 Gladstone Road, 31 DS0000005247.V293191.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 Gladstone Road, 31 DS0000005247.V293191.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. Gladstone Road, 31 DS0000005247.V293191.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Gladstone Road, 31 Address 31 Gladstone Road Bootle Liverpool Merseyside L21 1DG 0151 476 1964 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) Expect Limited Ms Tracey Jackson Care Home 3 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (3) of places Gladstone Road, 31 DS0000005247.V293191.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users to include up to 3 MD. Date of last inspection 14th December 2005 Brief Description of the Service: 31 Gladstone Road is a four bedroom terraced house situated in a residential area of Bootle. The home is registered to provide accommodation to three adults who need support with their mental health. The house provides 3 bedrooms, two lounges a small dining room and kitchen, in addition there is a sleep in room / office and enclosed back yard with seating. Parking is on the street outside. Staff are available 24 hours a day to provide support. The service provider for the home is Expect, formerly know as Sefton Support Services. This organisation is in the voluntary sector and is a registered charity. The registered Landlord for the property is Hornby Housing Association. Gladstone Road, 31 DS0000005247.V293191.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Information for this inspection report was gathered in a number of different ways. This included reading records and looking at the building. ‘Case tracking’ was used as part of the visit to the home. This involves looking at the support a person gets from the home including their care plans, medications, money and bedroom, time is also spent talking with the service user and with staff about how they meet the persons needs. Two service users were case tracked as part of this inspection. Any information the Commission for Social Care Inspection (CSCI) has received since the last inspection about the home is also taken into account along with information the organisation (EXPECT) have sent to the CSCI that was requested in a pre-inspection questionnaire. What the service does well: 31 Gladstone Road provides service users with a homely environment within a busy residential area. Before anyone moves into the home they are invited to visit several times with their families and a through assessment of their needs is carried out. This helps the person to make a decision about whether they want to move in and makes sure the home has enough information to decide if they can provide the support the person needs and wants. Care plans are in place for all service users, these provide staff with information about how to support the person with their health, personal care, leisure and lifestyle needs and choices. Service users are involved in their care planning and said they are happy with the support provided. The home has a long standing staff team, service users said they like the staff both in the home and the organisation and can talk to them about anything with one service user explaining, ““I like it here very much the people are nice” Staff are always helpful. Staff were seen to interact with service users throughout the day and to have a good understanding of service users, needs, choices and personalities and respond appropriately. Service users are supported to maintain contact with their families and friends who are welcomed to visit the home. The home supports service users to make everyday choices with one service user explaining,” I decide what to eat, “they ask me what would I like for my tea” discus with staff when to get up, depends on what I am doing that day, we discuss where to go together.” Gladstone Road, 31 DS0000005247.V293191.R01.S.doc Version 5.1 Page 6 Some 1-1 support is provided to service users to get out and about engaging in activities they enjoy. Health and safety checks and records are generally well maintained. What has improved since the last inspection? What they could do better: The organisation should look at the way in which they write information for service users, at present documents for service users are written very ‘formally’ and would be easier to understand if written in ‘plain engilsh’. As identified at past inspections the home needs to increase the ways in which service users participate in the home, this includes more involvement in everyday activities such as food shopping and seeking their views on how the home is run. The way medication is managed needs to be looked at, the home need to make sure all records of medication are permanent, unused medication is returned and medication with a short ‘use within’ date is dated when opened, this will help to reduce the risk of any errors occurring. Some areas of the home need repair or replacement work carried out, this includes a small area in a bedroom and the boiler area. The home needs to respond to service users comments during the inspection regarding wooden planks fitted over windows and provide a more acceptable solution if these are needed. There are not always enough staff working in the home to support service users to get out and about. The home needs to review staffing to make sure it is meeting service users needs, is flexible and provided at the right times. They also need to assess the risk to everyone in the home during the times there is only 1 staff available. Not all standards around staffing could be assessed at this inspection as files were locked away with no access available. The home needs to put a system into place to ensure access to staff files is available at inspection. Gladstone Road, 31 DS0000005247.V293191.R01.S.doc Version 5.1 Page 7 Not all staff had up to date training in fire or had taken part in a recent fire drill and some records of fire testing were not available. The home needs to make sure all staff are up to date in this area in order to make sure they act safely in the event of a fire. 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. Gladstone Road, 31 DS0000005247.V293191.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 Gladstone Road, 31 DS0000005247.V293191.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): 1,2,4 & 5 The quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The home provides service users with sufficient information about the service although the format of this is not always easy to understand. New service users have a full assessment and good introduction to the home, to make sure the home can meet their needs and that they wish to move in. EVIDENCE: Information about the home and the services offered is available in the form of a ‘welcome pack’, which is kept in the hallway for people to access. This provides information about the service, the aims and objectives of the home and organisation. Care plans looked at had a copy of the service users contract with the organisation, however for one service user this related to the previous home she has lived in and not to Gladstone Road. Contracts were signed by the service user and gave information about the terms and conditions of the home. Both the welcome pack and contracts are written in ‘formal’ language, which may not always be easy for service users to understand, although the welcome pack does state that copies are available in large print and on tape. As identified at previous inspections, the home should look at ways of providing this information in an easier to understand format, this includes use of plain engilsh instead of the more formal language used at the moment. The home must also make sure all service users have an up to date contract with the home. Gladstone Road, 31 DS0000005247.V293191.R01.S.doc Version 5.1 Page 10 One service user who had recently moved into the home and her keyworker explained that an assessment of her needs had been carried out before she moved in and that her family were involved in this. The service user explained, “ I came for my tea a couple of weeks and I liked it” whilst her keyworker explained that the move was well planned with the service user, familiar staff and her family involved in the process. Records showed that an assessment had been carried out by the local authority and that the organisation had held a meeting to plan the move and had carried out an indepth assessment to make sure the home could meet the service users needs. Gladstone Road, 31 DS0000005247.V293191.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): 6,7,8 & 9 The quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Service users care plans contain sufficient information for staff to support them with their needs and choices. Service users are encouraged to participate in some aspects of life in the home, however the home needs to continue to increase these opportunities. EVIDENCE: Care plans looked at were all up to date and contained information about how to support the person. Plans had been reviewed within the past 6 months and updated as the person’s needs changed. They contained information on how to support the person with their finances, their personal and healthcare support needs the things they do / do not like to do and their skills. The home aims to carry out a keyworker review of the plan each month, although one of these had not been competed in the past 2 months the plan had been altered to reflect changes in the persons lifestyle and their changing support needs. Gladstone Road, 31 DS0000005247.V293191.R01.S.doc Version 5.1 Page 12 Sections of the plans had been signed by the service user and one service user explained that her keyworker discussed her plan with her. Information about local advocacy services is available in the hallway for service users or their relatives to access if they want help with speaking up for themselves. One service user explained that, “I decide what to eat, they ask me what would I like for my tea, I discuss with staff when to get up, depends on what I am doing that day, we discuss where to go together. I like it here very much the people are nice”. Another service user said that staff explain things to her and that people from “the office” talk to her and ask her opinions. There are some restrictions on the things individual service users can do in the home, however this is written down in the risk assessment part of their care plan. Risk assessments covered many areas of the person lifestyle including their health, environment and activities. The reasons why a risk is identified and the actions staff need to take to reduce any risk to the persons health are also recorded. At the last inspection the home were given a requirement that service users should be more involved in the daily running of the home and in increasing their everyday skills. At times staff are still going shopping for food without service users, a member of staff explained this can be due to staffing levels or other planned activities. Although service users explained they are consulted about everyday choices there was no evidence that service user meetings are held or that they are involved in the running of the home. The home must look at ways in which they can consult and take into account service users views as to how the home runs and must develop a more flexible way to support service users to ‘run’ their home as much as possible rather than staff doing things for them. Gladstone Road, 31 DS0000005247.V293191.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): 12,13,14,15,16& 17 The quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Service users receive a good level of support with their relationships and adequate level of support with how they spend the day however the home needs to develop the support they offer service users in developing and meeting their lifestyle skills & choices. EVIDENCE: One service user explained that she goes to the local community centre twice a week for classes and also goes to Southport or Liverpool with staff on the bus and enjoys going to bingo at a local church hall. Daily records in the home show that staff provide support to the service user with different activities such as days out and shopping, eating out, leisure classes and housework. These also evidenced that service users are supported to visit friends and family and that visitors are welcomed to the home. The home is near to public transport, shops and cafes. As stated earlier in this report the home needs to look at ways of involving service users more in the everyday running of the home and household tasks. Gladstone Road, 31 DS0000005247.V293191.R01.S.doc Version 5.1 Page 14 A member of staff explained that staff rotas are usually planned around arranged activities for service users. However recent rotas showed that at times there is only 1 member of staff working in the home, staff agreed that this means service users cannot get out and about at those times. More information about this can be found in the staffing section of this report. Staff were seen to knock on bedroom doors before going into the persons room. One service user explained she did not have a lock on her bedroom door because, “ I don’t like it locked, they are going to get me a front door key” and another service user explained that she also did not like her room locked but had a front door key. Both said that they had been offered the choice of locking their room. Throughout the inspection staff were seen to sit with service users and spend time talking with or engaging in activities with them, whilst understanding their support needs and giving them time alone when it was evident this was what they wanted. A survey carried out by the company in October 2005 found that there was 100 satisfaction from service users for the support they receive with daily living. Each service user had an individual menu record, these showed that people are offered a choice of meals depending on their likes, dislikes and healthcare needs. Service users said that they like the meals provided and that staff ask what they would like to eat. A member of staff explained that sometimes staff eat with service users however this is not always possible due to the size of the dining area. Mealtimes were seen to be relaxed affairs with meals nicely presented and staff interacting with the service user. Information about any support the service user needs with their mealtimes and food and drink intake is recorded in their care plan. Gladstone Road, 31 DS0000005247.V293191.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, 20 & 21 The quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Service users personal and healthcare needs are met in line with their needs and choices Medication is usually but not always managed safely by the home EVIDENCE: A survey by the company in October 2005 found that 100 of service users were satisfied with the care and support provided by the home. Care plans contain a good level of information about the support service users need and prefer with regards to their personal and healthcare needs and choices. Staff work well in providing this support, for example one service users plan said that she likes to look nice and have her nails painted, in meeting with the service user it was evident that this support had been provided. Through reading records in the home and discussion with service users and staff it was evident that routines are flexible and based around the persons plans and choices, with one service user explaining, staff help her with having a shower and her medication and another explaining that, “I discuss with staff when to get up, depends on what I am doing that day”. Gladstone Road, 31 DS0000005247.V293191.R01.S.doc Version 5.1 Page 16 There are some adaptations fitted to the home to help people with their mobility and personal care and a service user and member of staff explained an Occupational Therapist had visited to suggest further adaptations, which would arrive shortly. Both service users spoken with knew who their keyworker was with one explaining, “Staff are always helpful, they are my friends, me and (keyworker) go back a long way”. The home provides good support to service users in accessing health care. Each service user has a health action plan and these showed that support is provided to access regular healthcare checks such as the Dentist and Optician as well as to attend health appointments and get medical or social worker referrals when needed. The home has a medication policy available for staff. Care plans contained information on the medication people take and the possible side effects of this as well as a plan for supporting people to take their medication correctly. Medication sheets looked at had been filled in correctly, however one had a sticky label on giving the name and does of the medication, the home should either use printed sheets from the chemist for listing medication or handwrite the prescription, with a second member of staff checking and witnessing the entry. This will ensure that there is a permanent record of the prescription available. The present system for collecting prescriptions is for the home to order these from the GP, the chemist then collects them and medication is collected from the chemist. The home should make sure that they see the GP prescription to help avoid any errors not being noted. Stock checks of medication are carried out regularly and records of these maintained. There were some medication stored in the cabinet that were no longer in use, the home should include a check of all medication storage areas along with the stock check of current medications to help prevent any errors. A recent medication error by the chemist was noted by staff after it had been given for several days, the home and organisation have now taken steps to reduce the risk of this happening again. The organisation has informed the CSCI that all staff have had medication training and a refresher course has been booked for the manager. Medication was stored correctly however one service user had creams that had been opened but not dated, the home must make sure that all creams, drops etc are dated once opened to make sure they are not used after the recommended timescale. Gladstone Road, 31 DS0000005247.V293191.R01.S.doc Version 5.1 Page 17 The homes service user guide states that if people become seriously ill the home will continue to support them where they can with advice from relevant professionals. Good practice was noted in that the home have supported one service user to complete a document titled, ‘when I die’, this gave the service user the opportunity to discuss death and dying and record their choices for the future. Gladstone Road, 31 DS0000005247.V293191.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 The quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The home listens to and acts upon any concerns, complaints or allegations that may affect service users. EVIDENCE: The home has a complaints book available for recording any complaints received and the outcome, no complaints have been received about the home by either the organisation or the CSCI since the previous inspection. Complaints, adult protection and whilst blowing policies are available in the home along with a copy of the local authority adult protection policy and procedures. Care plans contain information on service users finances including the support they need and how they like to spend their money. Service users are supported to hold their own bank accounts and can choose to have their money paid into this or to collect it from the head office. Records of service users monies held by the home were checked against the amount held and were correct. One service user explained, ““ I like to have money, I am happy with that” and that she chose what to spend her money on. Gladstone Road, 31 DS0000005247.V293191.R01.S.doc Version 5.1 Page 19 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): 24,25,26,27,2829 & 30 The quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The building meets service users needs and most but not all of their choices, it is clean and generally well maintained, however it would benefit from some refurbishment and redecoration. EVIDENCE: Based in Bootle the home is part of the local community and provides good access to local facilities and transport. There is enough space within the home for service users, visitors and staff, communal rooms include, a large downstairs lounge, small dining room, kitchen, enclosed back yard with seating and a small upstairs lounge. In addition there is an office / sleep in room for staff. All areas of the home were clean and most were nicely decorated with a comfortable atmosphere. The hall and stairs are looking shabby and would benefit from redecoration, staff advised that the company are aware of this and they hope to have the work carried out. The boiler room needs the flooring and décor replacing or repairing. Gladstone Road, 31 DS0000005247.V293191.R01.S.doc Version 5.1 Page 20 The home has an upstairs bathroom with new walk in shower and a bath with bath chair and there is a toilet available on each floor. Service users have large bedrooms, which are personalised with their possessions. Two service users spoken with said that they had chosen the décor and colour of their rooms. Both had a lockable drawer for personal possessions and said they could have a door lock but did not want one. The home has had a new boiler and radiators fitted, one service users bedroom needs the decoration repairing around the newly fitted radiator cover. All windows in the home are single glazed and most have a wooden plank approximately 4 X1 fitted half way up each window. Staff were unable to explain why this was there, but felt it may be for safety reasons. Two service users spoken with had strong views abut this, with one stating they did not like them and another, “ we are not fierce, we wouldn’t hurt anyone, we don’t need bars”. The home must look into the reason these planks are fitted, carry out a risk assessment and if needed, they must provide an alternative more acceptable to service users. Adaptations within the home include, a walk in shower, bath chair, stair lift and grab rails. Staff and a service user explained that an Occupational Therapist has visited to assess the home and plans to provide a new bath chair and 2nd handrail for stairs, however the service user confirmed the current bath chair is satisfactory for now. The home has a policy in place for infection control and provides disposable gloves and aprons. The washing machine is located in the kitchen in keeping with the principle of providing an ordinary lifestyle for people. The home should obtain some water-soluble bags to use in the event they have an outbreak of infection. Gladstone Road, 31 DS0000005247.V293191.R01.S.doc Version 5.1 Page 21 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, 33,34 & 35 The quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. There are not always sufficient staff working in the home to support service users to get out and about and there is no evidence that staffing levels are based upon service users needs. Recruitment policies within the organisation ensure that all checks are carried out on new staff to make sure they are suitable to work with service users. Staff do not always receive training updates within the recommended timescales. EVIDENCE: The home completed a questionnaire for the CSCI in which they state that 3 out of the 4 care staff hold a care qualification (NVQ). Throughout the inspection staff displayed a good understanding of service users and were able to read their verbal and non verbal communication and respond appropriately. A service user explained, “I like it here very much, the people are nice. Staff are always helpful, they are my friends” whilst another said that,”staff are very nice”. The home has a stable staff team and a service user explained that she was happy a member of staff she had known for a long time had moved to the house with her. There is a low staff turnover and the home has not used agency staff for some time, providing a consistent team to support service users. Gladstone Road, 31 DS0000005247.V293191.R01.S.doc Version 5.1 Page 22 The staff rota showed that at night times there is one member of staff sleeping in and during the day there is either one or two staff working. Staff confirmed that during the times one member of staff is working service users cannot get out and about but said that usually the rota is based around any planned activities service users have. On the weekend of 19th May 06 there was only one member of staff working in the afternoon of the Friday, Saturday and Sunday, therefore service users could not go out after 2 pm. There was no rationale on file stating why the staffing levels are as they are or whether they have been reviewed to take into account service users needs. The rota’s were not fully completed, with full dates and names of staff not recorded. The home must provide a written review and rationale of staffing levels based around service users assessed needs, they must also make sure rota’s are correctly completed. The home recruitment policy states that all necessary checks to protect service users are carried out as part of the recruitment process. A copy of the staff handbook is available in the home, this contains relevant polices including, grievance and disciplinary as well as information on terms and conditions of employment and the employee code of conduct. The manager was not working on the day of the visit, therefore staff files could not be checked, however no new staff have been employed for the home for several years. The home must make arrangements for access to staff files during CSCI visits. Training records for staff were not available. One member of staff spoken with said she had had training in medication, fire, health and safety and food hygiene but was unsure of her 1st aid training was up to date. Another member of staff said she had had recent training in medication and had had training in health and safety, fire, manual handling and food hygiene but was unsure if these are up to date. One member of staff held a care qualification and the other stated she would be willing to undertake this. The pre-inspection questionnaire completed by the home states they are, awaiting training for, Health and Safety, Fire, basic Food hygiene, Protection of Vulnerable Adults (POVA), Moving and handling & Behaviour Management. The home must provide a training plan which lists the training the team have undertaken along with when this is due to be renewed and ensure staff are up to date with basic care courses. Gladstone Road, 31 DS0000005247.V293191.R01.S.doc Version 5.1 Page 23 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): 37,39 & 42 The quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Service users are satisfied with the management of the home and organisation. Both the home and organisation have systems in place for obtaining service users views and reviewing the quality of care provided, however these need to be developed further. Health and safety is generally well managed within the home however fire training and records are out of date. EVIDENCE: The home has not had a Registered Manager in post for some time. This was noted at the previous inspection however to date no application from the appointed manager has been received by the CSCI. Following the inspection the appointed manager has advised the CSCI she has commenced the process of applying for registration. A member of staff explained there have been a lot of management changes within the home but described the present manager as ‘hands on’ and explained she is supportive. Another member of staff explained the organisation are supportive and ‘open to discussion’. Gladstone Road, 31 DS0000005247.V293191.R01.S.doc Version 5.1 Page 24 A service user described the manager as ‘lovely’ and both service users knew who people in the head office were and said they spoke with them and could talk to them. The home has a number of systems in palace for checking the quality of the service they provide. This includes daily handover checklists and regular staff meetings. A service plan for 2006 – 2007 is in place listing the aims and objectives of the home for the forthcoming year. The organisation carried out a service user survey in October 2005 this evidenced that service users are satisfied / very satisfied with the service the home provides. Service users were given time to talk with the Inspector during this visit and advised that they talk to staff and the organisation about how things are, as stated elsewhere in this report service users are not always fully consulted and involved in the daily running of the home and decision making. Health and safety records were looked at, these were satisfactory and up to date for, small appliances, electrics, gas, stair lift, water temperatures fire equipment and risk assessment. Fire escape routes and lights had recently been checked, there was no record of the alarm being tested since the end of March 2006, however staff advised this had been carried out more recently. A fire drill took place in March 2006 however not all staff took part in this, records stated ‘staff awaiting dates’ for fire training, this could effect the safety of anyone in the home in the event of a fire breaking out. The home must ensure fire records are up to date and that all staff participate in fire training and drills at recommended intervals. Polices and procedures are available in the home for health and safety and fire and risk assessment are completed for general health and safety issues. No risk assessment was available for the times when one member of staff is working alone in the house, as this can occur for a period of 20 hours at a time, the safety of service users and staff could be affected in the event that anything unexpected occurred. The home must carry out a risk assessment for these times and include the actions they are taking to minimise any risks. The home policies and procedures, statement of purpose and service user guide state that the service is committed to equal opportunities and treating people fairly and equally. Through observation during the inspection and the case tracking process it was evident that staff had a good understanding of people support needs and how this effects their needs and choices and provided support that took this into account. Gladstone Road, 31 DS0000005247.V293191.R01.S.doc Version 5.1 Page 25 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 3 ENVIRONMENT Standard No Score 24 1 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 2 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 2 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 3 2 X 2 X X 2 X Gladstone Road, 31 DS0000005247.V293191.R01.S.doc Version 5.1 Page 26 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 YA8 Regulation 12 (3) Requirement Service users must be given greater opportunities to be involved in the daily running of the home and encouraged to use and develop their independent living skills. This is a previous inspection requirement 2. YA36 18 (2) Staff must be provided with regular supervision. Previous inspection requirement 10/07/06 Timescale for action 07/08/06 3. YA5 5(1)(c) The home must ensure all 10/07/06 service users have an up to date contract The home must ensure all records of medication are recorded permanently. The home must carry out stock checks of all medications held and return unused items to the pharmacy. 26/06/06 4. YA20 13(2) 5. YA20 13(2) 26/06/06 6. YA20 13(2) The home must date any 26/06/06 opened medications, which have a ‘use within’ timescale. DS0000005247.V293191.R01.S.doc Version 5.1 Page 27 Gladstone Road, 31 7. YA24 23(2)(b) The home must repair / replace damaged décor and flooring in the boiler area and as identified in a service users bedroom. The home must look into the reasons why wooden planks are fitted across windows, carry out a risk assessment and if needed, provide an alternative more acceptable to service users. The home must provide a written review and rationale of staffing levels based around service users assessed needs. The home must ensure staff rotas are correctly completed The home must provide a system for access to staff files during CSCI inspections. 04/09/06 8. YA24 23(1)(a) 23(2)(a) 10/07/06 9. YA33 18(1)(a) 10/07/06 11. 12. YA33 YA34 17(2) 17(2) 26/06/06 26/06/06 13. 14. 15. YA42 YA42 YA42 The home must ensure fire records are up to date at all times 23(4)(d)(e) The home must ensure all staff participate in regular fire drills and training. 13(4)(c) The home must carry out a risk assessment for the times a member of staff is working alone in the home. 23(4)(a) 26/06/06 10/07/06 26/06/06 Gladstone Road, 31 DS0000005247.V293191.R01.S.doc Version 5.1 Page 28 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 YA35 Good Practice Recommendations The manager should produce individual training and development plans for each member of staff. The manager should also develop a training needs assessment and programme for the staff team as a whole. This training should be linked to the needs of the service users. This is a previous inspection recommendation 2. 3. YA24 YA5 The hall and landing should be presented more homely. This is a previous inspection recommendation The home should provide documents for service users in an easier to understand format, this includes the service user guide, statement of purpose and contract. The home should see service users signed prescriptions from the GP The home should obtain a supply of water-soluble bags 4. 5. YA20 YA30 Gladstone Road, 31 DS0000005247.V293191.R01.S.doc Version 5.1 Page 29 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG 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. 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