Inspection on 16/11/06 for Gracelands

This inspection was carried out on 16th November 2006.

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

Other inspections for this house

Gracelands 25/08/09

Gracelands 27/05/09

Gracelands 17/10/07

Gracelands 30/04/07

Gracelands 21/02/06

Gracelands 16/08/05

Gracelands 07/02/05

Gracelands 20/08/04

Gracelands 25/02/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Gracelands Ellesmere Road Whittington Oswestry Shropshire SY11 4DJ Lead Inspector Deborah Sharman Unannounced Inspection 16th November 2006 09:30 Gracelands DS0000038691.V316082.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 Gracelands DS0000038691.V316082.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. Gracelands DS0000038691.V316082.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gracelands Address Ellesmere Road Whittington Oswestry Shropshire SY11 4DJ 01691 652153 01691 652153 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) Loppington House Limited Miss Julie Palin Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Gracelands DS0000038691.V316082.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21 February 2006. Brief Description of the Service: Gracelands is registered with the Commission of Social Care Inspection (CSCI) to provide accommodation and care for seven people with a learning disability. The home is situated in the village of Whittington in North Shropshire. Loppington House Ltd owns the home and the Registered Provider is its Director, Mr Paul Harris. The Registered Manager for Gracelands is Ms Julie Palin. The seven people living at the Gracelands had previously lived at Loppington House and were chosen carefully for their compatibility. They were fully involved in the resettlement process, choosing decoration, furniture and fittings prior to moving into the home. The service users access a workshop and retail outlet two days a week where they are afforded the opportunities to experience making items to sell then actually selling the finished products. The Weekly fees charged range from £842.32 - £894.16 Gracelands DS0000038691.V316082.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was Graceland’s first inspection of this inspection year. This was a key inspection meaning that all key Standards were assessed in order to judge the home’s performance. This inspection which was carried out by one Inspector over an eight hour period was unannounced meaning that no one associated with the home received prior notification of inspection and were therefore unable to prepare. The quality of service provision was assessed in a variety of ways: through assessment of key documents including looking in detail at care provided to one service user and in less detail for a second service user, a tour of the premises and through observation of interaction between staff on duty and service users. The day of inspection was the Managers day off and so the Team Leader supported the process of inspection. However the Manager gave up part of her day off to introduce herself and stayed to support the rest of the inspection until she had to leave at 4pm. The Inspector was therefore able to formally interview the Manager, Team Leader and a staff member. It was not possible to formally interview service users. The Inspector however observed and heard interaction between staff and service users. Interaction was appropriate and service users were offered choices by staff. In spite of service users having challenging behaviour there was a calm atmosphere within the home. Prior to inspection the Inspector received positive written comments about the service from four service users and five relatives. This information was used to plan the inspection. Prior to inspection CSCI was notified by the home of an incident resulting in admission to Accident and Emergency and subsequent surgery for a service user. This also focussed the direction of the inspection. The Inspector was not able to inspect the management of service user finances as records were not available in the absence of the manager. The home has some strength but systems to support the protection of service users are not sufficiently developed. The home has not followed appropriate procedures. What the service does well: Gracelands DS0000038691.V316082.R01.S.doc Version 5.2 Page 6 Appropriate systems are in place for the admission of new service users to the home although as far as possible Gracelands is a home for life and vacancies do not generally arise. Currently the home has no vacancies. Staff have a good understanding of how to ensure that service users privacy and dignity is maintained. Access to health facilities and screening too is good. Staff receive access to frequent training to prepare them for their role and good training systems are in place to plan and monitor training opportunities. There is a good format in place for care planning which will provide a good foundation for further improvement in written guidance available to staff. Feedback to CSCI prior to this inspection has been positive. With support from an employee of the company, service users stated ‘happy, like it at Gracelands’, ‘happy, good’ ‘carers help me’, staff are ‘nice’, ‘I help hoover’, staff are ‘ok’, ‘I’m happy and like it’. What has improved since the last inspection? What they could do better: Several areas for development were identified and discussed with the Managers at Gracelands. These include: • • • Developing care plans to guide staff that address all areas of service user need as only personal care guidelines are currently in place. Improving some aspects of medication management to promote service users health and safety. Identifying incidents between service users as potential adult protection incidents, taking necessary steps to protect the rights of all service users to live free from physical assault and intimidation. Gracelands DS0000038691.V316082.R01.S.doc Version 5.2 Page 7 • • Ensuring that all staff know how to diffuse rather than escalate service user behaviours for the welfare and safety of service users and staff. Ensuring that Managers at Graceland’s receive frequent and recorded formal supervision to ensure the home’s development in line with the National Minimum Standards. 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. Gracelands DS0000038691.V316082.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 Gracelands DS0000038691.V316082.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): 2 Quality in this outcome area is good. Appropriate procedures are in place that the Registered Manager is familiar with to enable the successful admission of new residents to the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Gracelands does not have any service user vacancies and as it provides, where possible, a home for life there have been no vacancies since the home first opened. Gracelands provides Loppington House service users with a home to move on to, so should there be a vacancy, referrals would not be considered from elsewhere. Discussion with the manager showed her to be familiar with admissions procedures having implemented them when the current group of service users moved in. Discussion showed there to have been a lengthy transition period which was dictated by the needs and at the pace of the individuals involved. Gracelands DS0000038691.V316082.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is adequate. Staff spoken to appear to broadly understand service user need but care planning is insufficient. There is a good formula for care planning in place which can be used to develop the current range of care plans to ensure the potential for error is avoided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans provide excellent detailed information for staff about personal care and are based upon service users abilities and independence. Care plans for a diabetic person did not direct staff as to how blood sugar levels should be monitored. The Manager and staff were also unsure how they were going to support a non - compliant service user during a forthcoming hospital appointment. In addition discussion with staff indicated that a service user has some mobility needs. Inspection of his assessed needs and care plan give no indication of the extent of these needs or intervention required to promote his independence and safety. Gracelands DS0000038691.V316082.R01.S.doc Version 5.2 Page 11 Care plans are being reviewed monthly but alterations to the care plan are not being fully documented. It is positive however that in practice medical advice had been followed ensuring positive outcomes for the service user. Multi disciplinary reviews are being held albeit annually and not six monthly as required. The Inspector overheard staff offering choice, for example, what do you want on your toast? Would you like to come and show the Inspector your bedroom? The Inspector observed staff respecting service users’ responses to these questions. There is some evidence in shift records of service users being offered the option of going to their bedroom to calm down when agitated. It was positive to see evidence that a service users refusal to go to his / her bedroom was respected in spite of several requests being made. Risk assessments are in place for individual service users and records indicate compliance with control measures in place for one identified risk sampled. Gracelands DS0000038691.V316082.R01.S.doc Version 5.2 Page 12 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): 12, 13, 15, 16, 17. Quality in this outcome area is adequate. There is evidence of some activity and access to the community although individual interests and needs could be better met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Discussion with the manager and Team Leader indicate that service users are supported to maintain contact with family although there was no formal evidence of letter writing or phone calls for those who have limited family contact. The Visitors book evidences regular family contact for those who have family that visit. Staff seem to be aware of arrangements for family contact although care plans do not provide them with the necessary guidance as agreed with families. Gracelands DS0000038691.V316082.R01.S.doc Version 5.2 Page 13 Records evidence four visits in a month within the community for the service user case tracked (over and above formalised day activity). There was no evidence however of him being supported to access community services and little evidence of him pursuing activities within or outside the home in accordance with his assessed interests and preferences. From the records the Inspector observed there may be a link between activity levels for this service user and the manifestation of behaviours that challenge and it would be useful for the manager to formally monitor this. Hobby days now take place once per month instead of every Wednesday in order to comply with the requirement to increase staffing levels and activities at weekends. Instead, service users access additional days at Loppington House. Discussion with two staff members indicated concern about the impact of staffing levels on activity and this concern is also included in a copy of a staff questionnaire made available to the Inspector upon request. A staff member stated activities are group based rather than individual due to pressure on staffing levels. Menus are seasonal and work on a five-week rolling menu, which is checked by the cook at Loppington as Gracelands does not have a qualified cook. The planned menu for the day of inspection was adhered to and it was pleasing to see that the meal was home cooked and not ready made convenience food. Gracelands DS0000038691.V316082.R01.S.doc Version 5.2 Page 14 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, 20 Quality in this outcome area is generally good. The provision of personal care and access to health screening and treatment is good. Staff have done well to achieve good health screening outcomes for a service user who does not comply well with health monitoring and treatment. Omissions in some areas of staff training and in some aspects of medication practice potentially increase risk to the health and welfare of service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans contain very good written guidance detailing how to meet service users personal care needs. From observation service users present as well groomed with attention to individual style being evident. Staff ably demonstrated as having a good understanding of how to promote service users dignity and privacy - for example all service users were wearing dressing gowns in communal areas of the home when the Inspector arrived. A wheelchair has been donated to a service user. The Manager should ensure Gracelands DS0000038691.V316082.R01.S.doc Version 5.2 Page 15 that it is checked and that in future service users are assessed for wheelchairs by a person competent to do so to assure its safety, comfort and fit. Although written guidance is not available to support staff to meet service users general and specific health care needs, records indicate that health screening for service users is good. There was evidence of the following having been provided for the service user whose care was tracked: • • • • • • • • Yearly medical with GP, Psychiatric review, Flu vaccine, Dentist checks ups and follow up including surgery in hospital to achieve treatment required, Eye tests, Chiropody, Diabetes monitoring of blood levels, Accident and Emergency admission involving surgery as a result of an incident at the home. Whilst hospitalised the service user received constant support from Gracelands staff. Staff have received training in the use of intimate procedures but not from medically qualified or authorised staff. This compromises the integrity of the training, potentially putting service users at risk and failing to protect staff. Staff have also not received training in the management of diabetes although the Manager has tried to commission this. An incident requiring surgery and the subsequent removal of stitches for a service user who struggles to comply with medical treatment has highlighted the need to plan for how service users will be supported in a medical emergency. From case tracking, ‘as required’ medication to manage behaviour is being rarely used and residents are therefore not being over medicated. Good systems are in place to prevent this. Systems need to improve in relation to the administration of homely remedies as medical guidance in relation to their use is not available to staff. It was concerning to find that Ibuprophen (400 mg) prescribed for one service user had been allocated for use by another as a homely remedy by amending the name on the packets directions. This is poor practice although it is not known whether any had been used. The integrity of the Medication Administration Records was difficult to assess as temporary sheets had been used because the chemist had failed to issue pre printed ones at the time of dispensing. The permanent record was therefore being completed retrospectively but was incomplete. Gaps were evident on the temporary sheet and reasons for none administration Gracelands DS0000038691.V316082.R01.S.doc Version 5.2 Page 16 had not been indicated. Gaps within the temporary record appeared to be particularly prevalent for a number of service users on Mondays. Whilst inspecting medication stocks (medication is stored well) a staff member identified a tablet that had not been administered to a service user at the required time earlier in the day and took corrective action. All staff with the exception of one have undertaken Accredited training in the Safe Administration of Medication. Although in house systems are in place to assess staff competency to administer medication, this should not be carried out by staff who have not completed accredited training. The staff member who is awaiting this training is administering medication to service users unnecessarily increasing risk. The risk is unnecessary because positively the home has a witness system in place where a second staff member observes administration to reduce the risk of error. Qualified staff who could have taken responsibility for the administration were working as witnesses to the unqualified staff member. This offers some but not full protection. There have been two recorded medication errors in 12 months. These have not been reported to CSCI under Regulation 37 and although medical advice was sought on the first occasion medical advice was not sought on the second, different occasion. Gracelands DS0000038691.V316082.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. Quality in this outcome area is poor. Gracelands has appropriate policies and procedures in place for the protection of service users. Staff and management generally have a good understanding of how to protect vulnerable adults but have not implemented this where incidents have happened between service users. Improvement will benefit all service users emotional welfare and safety. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Responses from relatives prior to inspection indicated that none had had to make a complaint. Inspection of the well-structured complaints log verifies this and no complaints have been made to the Commission for Social Care Inspection in respect of this service. A relative who maintains contact but visits the premises infrequently stated that they do not know how to make a complaint. The Manager and Inspector discussed ways that the Manager could ensure that complaints processes are communicated to those people who may not see advice posted within the premises. There have been no allegations, no disciplinary action against staff and all staff have undertaken adult protection training. The Manager has previous experience of following multi agency adult protection procedures and along with the Team Leader has a good understanding of priorities, responsibilities and limitations of their roles in the event of an overt allegation. However Gracelands DS0000038691.V316082.R01.S.doc Version 5.2 Page 18 incidents between service users (where one service user has slapped, punched and has almost pushed a service user down the stairs) have not been identified as adult protection and action to protect others has not been taken. Records of incidents indicate that service users who are the recipients of these behaviours feel threatened. These incidents have not been reported to CSCI. The Inspector highlighted records of an incident to the Manager where it appeared that a staff member’s response to a service user had exacerbated rather than diffused a situation. The Manager shared the Inspector’s concern and said that she would address the matter. The management of service users money was not assessed as records were not available for inspection at the time requested due to the absence of the manager and deputy but the Inspector was told that an advocate regularly audits them. Gracelands DS0000038691.V316082.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30. Quality in this outcome area is adequate. The environment generally provides homely, domestic style accommodation for service users with sufficient space to meet their needs. There are some omissions in maintenance and safety emerging which require attention to ensure that a good environment is provided for service users comfort, pleasure and well-being. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The premises are fresh smelling throughout with no malodour. Paintwork and décor is clean too. Bathrooms are dated however and plans to refurbish are required. The premises are spacious and the ambiance calm. Service users were seen enjoying communal space uninhibited by others. The Environment largely meets the needs of the service user case tracked through the provision of personalised ground floor accommodation and encased televisions for safety reasons in the event of aggressive behaviours. Gracelands DS0000038691.V316082.R01.S.doc Version 5.2 Page 20 Further steps could be taken to ensure the suitability of the environment as a result of this service users new behaviour. For example, the wardrobe is not restricted and the chest of drawers, which the Inspector learned have been thrown, is not restricted. Fragile bedroom shelving is also not restricted from toppling presenting the risk of property damage and possible personal injury. Given that the serious injury incurred by the service user was a result of challenging behaviour against a pane of glass, the safety of glass within the premises must be reviewed. Two holes in the wall where the service user has slammed the door back against the wall evidence the risk to property and self and have not been repaired. Keys are not provided and the reason is accounted for through risk assessment. Ensuites are not available but a basin is in the bedrooms. The Inspector sampled the water from the bedroom basin and it was acceptably hand hot reducing the risk of scalds. Risk assessments do not account for the decision not to restrict windows. Providing further risk, but from fire, is the observed practice of propping open fire doors with wooden wedges. This is unsafe and in the event of fire would enable the rapid spread of fire and smoke. Laundry facilities were found to be clean and readily cleanable. Discussion with staff showed that in the absence of mechanised aids that practice is to manually sluice. Guidance against cross infection was not posted within the laundry and discussion showed a staff member to need support re how to minimise the risk of cross contamination both within and during the transportation of soiled items to the laundry. Staff said that soiled articles are transported without containment throughout the premises to the laundry. The Provider states that the Environmental Health Officer considers infection control risks to be low. Gracelands DS0000038691.V316082.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 Quality in this outcome area is adequate. There is a good training Programme supported by the regular supervision of staff. Established staff therefore are sufficiently competent. However, there is a high use of agency staff for whom required records are not available. This judgement has been made using available evidence including a visit to this service. EVIDENCE: No new staff have been recruited since the last inspection. The home is using a significant amount of agency staff as 90 care hours per week remain vacant. Unsupervised night shifts where staff work alone are entirely staffed currently by agency staff. How the home ensures that checks are available for any staff supplied to it by an agency was therefore assessed. No recruitment checks are available for agency staff. The Manager has a general letter from the Agency confirming that checks are undertaken but there is no evidence at all that the policy of the agency has been successfully adhered to in each individual circumstance. The Manager therefore has not sufficient assurance that individual agency staff working on the premises presents no risk to the service users at Gracelands. However the Manager is satisfied with the calibre of staff Gracelands DS0000038691.V316082.R01.S.doc Version 5.2 Page 22 provided. Continuity has been enabled by the supply of regular staff from the agency. The Manager stated that in the absence of cooperation from the agency she would attempt to secure copies of recruitment checks from the staff sent by the agency but acknowledged that this would not be achieved prior to their commencement at the home. A comprehensive and up to date training matrix identifies few omissions in staff training. Training certificates were randomly sampled to evidence the accuracy of the matrix. Fifty percent of staff have NVQ, meeting the national target. However a staff member without accredited medication training is unnecessarily administering medication and staff have received training in intimate medical procedures from a staff member not qualified to do so and this requires review. Following initial compliance, induction to the required National Standard is not now in place for new staff. The Manager explained that the organisation subscribes to the Learning Disability Award Framework induction training (LDAF) but that for some staff this has been omitted. Although there have been no new staff appointed recently, this change in practice has left those staff last appointed without an induction to the required Standard. A programme of supervision, which is robustly evidenced, is in place and is being successfully implemented by the Team Leader. A misunderstanding however which he indicated could be easily remedied has meant that staff have been receiving four supervisions per year plus two appraisals rather than a minimum of six supervisions in addition to any appraisal. The home is not able to evidence that its staffing levels are currently meeting the needs of service users. Athough on paper it appears that levels assessed as required are being met, this is achieved by the manager providing 32 hours hands on care. The need for additional domestic support has been identified and is to be provided one day per month from Loppington House. The commencement of this has been delayed, as the cleaning staff cannot travel to Gracelands. Assessment of the rota, which had not been updated to reflect amendments to staffing during a service users period of hospitalisation, shows that two staff are usually on duty with three staff occasionally. The Provider states that day staff from Loppington House also support the home and the rota does not reflect this. Two staff expressed concern about this for two reasons. Firstly, given the levels of challenging behaviour and secondly problems were experienced identifying staff to cover prior to being able to admit a service user to Accident and Emergency over the previous weekend. On this occasion there was no undue delay but any further unforeseen event could have seriously compromised the homes ability to meet service users urgent needs. The Provider however feels that contingency arrangements are satisfactory. Gracelands DS0000038691.V316082.R01.S.doc Version 5.2 Page 23 A requirement to increase staffing levels at weekends has been deleted. This has been achieved by rescheduling mid week staffing and the provision of activities once weekly at Loppington House. Gracelands DS0000038691.V316082.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): Quality in this outcome area is adequate. Staffing levels and high levels of service user need are putting strain upon the homes resources. The Manager is not being provided with sufficient support to maintain good quality. More requirements have arisen from this inspection. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Manager has now completed her Registered Managers Award and NVQ 4 in Care and is awaiting certification. She has in addition attended some update training this year. Staff spoke highly of the manager but one staff member described her as ‘exhausted’. The staff member explained this was because she had worked 36 additional hours to provide a service user with support following an unplanned admission to hospital following a serious accident at the home resulting from challenging behaviours. Gracelands DS0000038691.V316082.R01.S.doc Version 5.2 Page 25 The Manager (who is allocated one day per week for management tasks) and the Team Leader have not received frequent supervision. The Registered Managers last supervision was in February 2005 and her last appraisal was in October 2002 shortly after the home opened. The Team Leader who is also supervised by the provider last received supervision in October 2005 and an appraisal of performance in March 05. All staff including Managers are entitled to a minimum of six supervisions annually and an annual appraisal. Team meetings could not be evidenced on the day of inspection but five meetings held in 2006 have been evidenced since. There have however been regular regulation 26 visits to the home by the provider and these are documented. However there is no evidence of Quality assurance systems and concerns that assaults upon service users by another service user have not been identified as possible adult protection incidents. In addition a friend has provided a service user with a wheelchair for occasional use. The home therefore cannot guarantee that the wheelchair is an appropriate size or fit and its safety cannot be assured, as it was not serviced at the time of receipt or since. All other service documentation sampled is up to date assuring the safety of the premises and its fixtures and fittings. Hazardous chemicals are stored safely but COSHH assessments and data sheets were not available for four hazardous chemicals randomly sampled by the Inspector. Fire training is provided annually and agency staff received basic fire awareness information upon staring at the home. They must be included however in forthcoming full fire training. Staff interviewed at the time of inspection expressed concerns about the possible financial viability of the home as they are under the impression that ‘there are no spare funds’ to develop the service further. A number of new requirements have arisen as a result of this inspection. Gracelands DS0000038691.V316082.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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 1 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 2 X X 2 X Gracelands DS0000038691.V316082.R01.S.doc Version 5.2 Page 27 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 15 Requirement The Registered Manager must ensure that all care plans are further developed to cover all aspects of personal, social and Health care needs as set out in Standards 2, 6, 7, 9, 13, 15, 16, 17, 19, 20. The plan must be reviewed with the service user involving significant professionals and family etc as agreed at least every six months (by June 2007) The care plan must be updated to reflect changing needs. New Requirement November 2006. 2 YA13 16(2)(m)(n) The Registered Manager must 14 ensure that service users are 15 supported to participate in the local community in accordance with assessed needs and the individual plans. New Requirement November 2006. Gracelands DS0000038691.V316082.R01.S.doc Version 5.2 Page 28 Timescale for action 31/03/07 31/03/07 3 YA18 23(2)c 23(2n) The Registered Manager must ensure that the provision of technical aids and equipment e.g. wheelchairs are determined by professional assessment, reviewed and changed where appropriate and regularly serviced. New Requirement November 2006. 31/03/07 4 YA20 13(2) 37 Medical advice must be sought 31/03/07 and recorded in relation to each service user about the use of homely remedies. Prescribed medication must only be administered to the person for whom it is prescribed. The Registered Manager must develop a system, which ensures that gaps in Medication Administration Records are identified without delay, investigated, and appropriate action taken. All errors in medication must be reported in writing to CSCI without delay. All staff must receive Accredited Medication training prior to administering medication. New Requirement November 2006. 5 YA23 13(6) Action must be taken in response to all incidents of abuse including service user to service user to protect the interests of all service users. 01/03/07 Gracelands DS0000038691.V316082.R01.S.doc Version 5.2 Page 29 The Registered Manager must take action to ensure that physical and verbal aggression by a service user is understood and dealt with appropriately by all staff to protect the rights and best interests of the service user. New Requirement November 2006. 6 YA24 13(4) 23 Based upon the assessed vulnerabilities of service users, the Registered Manager must assess the level of risk posed by toppling furniture, glass and unrestricted windows and must take action to reduce the level of risk where risk is identified. The Registered Manager must ensure damage to the bedroom wall (behind the door) is satisfactorily repaired and the décor made good. New Requirement November 2006. 7 YA24 23(4) The Registered Manager must ensure that the practice of wedging fire doors open ceases. New Requirement November 2006. 8 YA32 18 The Registered Manager must ensure the provision to all staff of Diabetes Awareness training. The Registered Provider must review how training is provided in the administration of Rectal Diazapam and the use of epi pens. 31/03/07 31/03/07 31/03/07 Gracelands DS0000038691.V316082.R01.S.doc Version 5.2 Page 30 New Requirement November 2006. 9 YA33 18 Staffing hours for ancillary tasks must be kept under review The actual staff rota must be maintained to accurately reflect actual staff provided. New Requirement November 2006. 10 YA34 19 The registered person shall not allow a person to whom paragraph (2) applies (a person who is employed by a person other than the registered person) to work at the care home unless— (b) The employer has obtained in respect of that person the information and documents specified in— (i) Paragraphs 1 to 9 of Schedule 2; And has confirmed in writing to the registered person that he has done so; The provider must review the current practice of agency recruitment checks in light of the above Regulations. New Requirement November 2006. 11 YA37 9 The Manager and Team Leader must be provided with a minimum of six supervisions sessions per year with written records retained. DS0000038691.V316082.R01.S.doc 31/03/07 31/03/07 31/03/07 Gracelands Version 5.2 Page 31 New Requirement November 2006. 12 YA39 24 The registered person shall establish and maintain a system for evaluating the quality of the services provided at the care home based upon consultation with service users and or their representatives New Requirement November 2006. 13 YA42 13(4) The Registered Manager must ensure that COSHH assessments are in place for all hazardous chemicals on the premises and that COSHH assessments are carried out using up to date data sheets. Agency staff must be included in Fire Training arranged by the home for November 2006. The Registered Manager with the Registered Provider must review how the home will provide induction training to new staff consistent with National requirements. New Requirement November 2006. 31/03/07 31/03/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Gracelands Refer to Standard Good Practice Recommendations DS0000038691.V316082.R01.S.doc Version 5.2 Page 32 1 YA23 It is recommended that the Registered Manager monitor the relationship between activity levels and behaviour that challenges. New Recommendation November 2006. Gracelands DS0000038691.V316082.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE 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. 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