Inspection on 25/10/06 for Grammar School House

This inspection was carried out on 25th October 2006.

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

Grammar School House 21/02/06

Grammar School House 05/10/05

Grammar School House 08/02/05

Grammar School House 17/08/04

Grammar School House 30/03/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Grammar School House York Road Earls Colne Colchester Essex CO6 2RB Lead Inspector Kathryn Moss Key Announced Inspection 25th October 2006 10:00 Grammar School House DS0000040901.V317520.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 Grammar School House DS0000040901.V317520.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. Grammar School House DS0000040901.V317520.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Grammar School House Address York Road Earls Colne Colchester Essex CO6 2RB 01787 222412 01787 221814 grammar@caringhomes.org 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) Grammar School House Limited Mrs Janine Formoy Care Home 13 Category(ies) of Learning disability (13), Physical disability (13) registration, with number of places Grammar School House DS0000040901.V317520.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Persons of either sex, under the age of 65 years, who require care by reason of a learning disability who may also have a physical disability (not to exceed 13 persons) 21st February 2006 Date of last inspection Brief Description of the Service: Grammar School House is an older style property, situated in the village of Earls Colne, with access to local towns. The home is divided into two selfcontained units, one (the ‘Annex’) for six more independent service users, and the other (the ‘Seven-side’) for seven more dependent service users. Each side of the home has its own lounge and dining areas, and a small kitchen; both sides share laundry and garden facilities. All service users have single bedrooms. At the time of this inspection there were twelve service users in residence. The home is registered to provide care to thirteen younger adults with a learning disability and/or physical disability. Although a learning disability is the primary need of current service users, one or two have an additional physical disability or medical condition (e.g. epilepsy). The home is owned by Caring Homes Ltd. and the registered manager is Janine Formoy. The inspector had been advised on previous inspections that the home prefers to refer to service users as ‘clients’, and so this term will be used in this report. A statement of purpose and service user guide are available at the home. Current fees at the home range from £649 to £1,100 per week, based on information provided to the CSCI in January 2006. Grammar School House DS0000040901.V317520.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place on the 25/10/06, lasting eight hours. The inspection process included: • • • • • Discussion with the registered manager and the area manager; Discussions with four care staff; Discussions with three residents and time spent with or observing other residents. An inspection of the premises, including a sample of bedrooms, the laundry, communal areas, and one bathroom. Inspection of a sample of records; 28 Standards were covered, and 4 requirements and 12 recommendations have been made. On the day of this inspection, the home was maintained in a good condition. There were 12 service users living in the home: clients were receiving good care and support, and those spoken to enjoyed living at Grammar School House and were positive about the staff team. What the service does well: What has improved since the last inspection? Although further training is needed, it was good to see that the home had managed to access some training for staff in Communication Skills. This is important because many of the clients have no verbal communication, and limited ability to communicate in other ways. It is therefore important for staff to be able to maximise clients’ abilities, and to develop the skills to communicate with them. Grammar School House DS0000040901.V317520.R01.S.doc Version 5.2 Page 6 The home had made significant progress in refurbishing the Seven-side of the home. At the last inspection there were several areas that needed to be addressed and extensive work had since taken place, including replacing the flooring in the hallway and dining room, decorating and re-furnishing the dining room; refurbishing the bathroom (including installing an assisted bath); and decorating the lounge. This has greatly helped to improve the living environment for clients. What they could do better: 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. Grammar School House DS0000040901.V317520.R01.S.doc Version 5.2 Page 7 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 Grammar School House DS0000040901.V317520.R01.S.doc Version 5.2 Page 8 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, 3 and 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s admission processes ensure that prospective service users’ needs are assessed and that the person has opportunity to visit the home, enabling both staff and clients to be confidant that the home can meet their needs. EVIDENCE: The home’s Statement of Purpose and Service User Guide were not inspected on this occasion. There have been no significant changes within the home since these documents were last reviewed. Whether they are available in alternative formats was not discussed on this inspection. One new client had come to live in the home since the last inspection. A comprehensive assessment process had been carried out by the home, including visits by Grammar School House staff to meet the person in their previous placement, and several visits to the home by the prospective client. The manager stated that these visits had been recorded but these records could not be located at the time of the inspection. There was evidence that full assessment information (including behavioural needs) had been obtained from Grammar School House DS0000040901.V317520.R01.S.doc Version 5.2 Page 9 the care manager and the previous placement, and the home had also completed a pre-admission form covering physical care needs. From these a service user plan had been developed (see next section). Care plans viewed for the new client contained clear information on the support required to meet their assessed needs, including behavioural needs; there were systems in place for monitoring this individual’s behaviour and for involving them in addressing this. The new client seemed content and settled in the home, and said they were happy with the support received from staff. Staff spoken to showed knowledge of all clients and an understanding of any special needs (e.g. epilepsy, lack of verbal communication/inability to communicate choices, etc.). Staff had received recent training in Physical Intervention and Communication Skills: whilst the provision of training in Communication Skills should be ongoing within the home, it was good to see that some initial training had now been provided. The manager felt that the Physical Intervention training had given staff more confidence to deal with challenging behaviour. No minority groups being catered for at the time of this inspection. The home does not currently have access to independent advocacy services to support clients through the process of choosing a home, if required (see also next section). Grammar School House DS0000040901.V317520.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 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users’ assessed needs are reflected in their individual plans; any risks involved in daily activities are identified and assessed in order to minimise risks and encourage independence. Decision making by service users is supported in the home. EVIDENCE: Only the care plans for the new client were inspected on this occasion. These covered relevant issues and contained clear details of action required by staff to support their needs. As well as personal care needs, care plans also covered issues such as communication and feelings, behaviour management, personal finance, relationships and activities. Where relevant there were clear risk assessments to support the care plans, identifying any risks involved with aspects of the person’s care or their daily activities. Care plans were noted to mainly focus on meeting core needs, rather than on identifying and addressing Grammar School House DS0000040901.V317520.R01.S.doc Version 5.2 Page 11 the person’s hopes and aspirations: the manager stated that the home is intending to develop Person Centred Plans as a way forward with this. There was not yet evidence of reviews on this person’s file: however, it was noted that the person had only just been living in the home for six months and therefore their review was due. The availability of alternative care plan formats was not discussed on this inspection. A key worker had been allocated to this client, and when spoken to they were aware of who their key worker was and were positive about them. Where clients were able to make decisions for themselves, from discussion with clients and staff it was clear that they were encouraged and supported to make decisions, and provided with appropriate information to assist them (e.g. activities, holidays, food, spending money, etc.). Where able, clients were supported to manage their own money with assistance and guidance from staff where necessary (e.g. to keep money safe, and to advise on purchases, etc.). Many of the clients in the home were not able to actively make choices and decisions for themselves: two staff spoken to about this were able to clearly describe how they offered people choices and how they based any decisions made on clients’ behalf, both showing good knowledge of how specific clients showed their likes or dislikes. In another instance where a client was not able to indicate their preferences, discussion with their key worker showed that a great deal of care and thought went into making appropriate decisions about their room décor, clothing and activities. No advocates were involved with anyone in the home at the time of this inspection. The home does not have access to any advocacy support, and would refer this to social services if a need were identified. Grammar School House DS0000040901.V317520.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, 14, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides flexible daily routines, enabling service users to engage in activities of their choice. Local community resources are regularly accessed, and the home supports service users to maintain contact with relatives. The home provides a varied and healthy diet. EVIDENCE: Current clients living at Grammar School House have limited capacity to be engaged in employed or voluntary work. However, they are encouraged to take part in further educational activities, and several clients attend adult education classes at college (e.g. ‘numbers and letters’ and ‘communication skills’). A college tutor also provided some classes within the home, and clients were positive about these, clearly enjoying them and benefiting from Grammar School House DS0000040901.V317520.R01.S.doc Version 5.2 Page 13 the input. Clients were supported to continue to engage in other valued interests and leisure activities (e.g. horse riding and swimming). The home has a part-time activities co-ordinator, and an additional activities person who provides five hours a week support in the evenings. Evidence of activities schedules seen during the inspection showed that most clients now had busy weekly programmes, with a wide range of activities taking place both in and outside of the home. It was noted that even those clients with least capacity to participate were now involved in more activities (including use of the Snoozelem room and going out for walks locally). The home has shown a significant improvement in developing activities over the last couple of years, and this year had raised money to purchase a trampoline for the garden, and through the provision of some additional activities co-ordinator hours had enabled more activities to take place in the evenings (e.g. bingo nights and Health and Beauty evenings). The home was making good use of community facilities, including colleges, leisure facilities, shops, pubs, etc., with some clients also attending centres or groups run by other organisations (e.g. a drop-in social centre, an evening disco, etc.). At the time of the inspection clients were preparing for, and clearly looking forward to, several Halloween parties including two they had been invited to through their links with other centres. Activities at colleges included courses involving dance, relaxation and music. No clients currently attended local churches, but have done in the past. Clients had been on a range of holidays during the year (some on more than one), and those spoken to had clearly enjoyed these. The file of a new client showed a clear record of weekly activities in the form of a weekly ‘programme report’ showing whether planned activities had taken place (and if not, why not), and included comments and feedback on whether the person had enjoyed and benefited from the activity. Another ‘activities log’ recorded other non-programmed activities (e.g. walk, pub lunch, etc.). These records demonstrated good progress on both the provision of activities and the recording and monitoring of these. Staff supported service users to attend local day centres and an evening disco, to enable them to develop links and friendships with people outside of the home. On previous inspections it was noted that the home supports clients in maintaining relationships with their families, including encouraging visitors, facilitating telephone calls and maintaining communication with family members, and by taking clients to visit their families. Observations on the day of the inspection indicated that daily routines were flexible within the home, and that day-to-day choices were encouraged and promoted. Clients were observed to be free to spend time in their rooms or in communal areas within their part of the home; where able, clients could have a key to their room. In the annex, clients were encouraged to assist in daily Grammar School House DS0000040901.V317520.R01.S.doc Version 5.2 Page 14 tasks where able, and had responsibility for certain daily tasks. This was not seen specifically recorded in the sample care plan viewed, and it is recommended that responsibility for household tasks is included in care plans. Staff were seen to spend time with clients and to interact well with them. The home’s menus are based on knowledge of clients’ likes and dislikes, or from consultation with clients (in the Annex). Menus previously seen showed a good range of balanced meals: staff spoken to said that there was flexibility to change the menu, felt that food supplies were of a good quality and quantity, and reported that they had scope to vary food orders from week to week. Clients spoken to were positive about the meals served and on the day of the inspection the lunch served looked and smelt appetising. Staff spoken to were knowledgeable about clients’ likes and dislikes, and about their mealtime routines (including any special needs). At the last inspection the dining room floor and decoration on the Seven-side had been in a state of poor repair: this room had since been repaired, decorated and re furnished, and now presented a pleasant environment for meal times. Grammar School House DS0000040901.V317520.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users were receiving appropriate support with their personal care, resulting in personal care being well maintained. The home provided support to meet physical and emotional health needs, accessing the necessary medical support and advice to promote service users’ health. The home’s medication practices provided safe systems of storage and administration. EVIDENCE: The Individual Plan (care plan) viewed described what support the person needed with their personal care, mobility and health care needs, and how staff should provide this. It also provided details of the support required to manage any challenging behaviour and it was good to see that the client was involved in identifying what made them angry or happy and relaxed, and keeping a ‘Feelings Diary’ to record any incidents of challenging behaviour. Clients spoken to were happy with the support given to them by staff; they were also happy with their key worker and it was clear that their wishes and needs had been taken into account when matching them with key workers. It was clear Grammar School House DS0000040901.V317520.R01.S.doc Version 5.2 Page 16 that key workers encouraged and assisted clients to make their own choices regarding hairstyles and clothing, or made choices based on their knowledge of a person’s likes and personality. On previous inspections it was noted that files showed contact with health care professionals, and that the home sought appropriate specialist support for clients, assisted them to attend appointments, and had involved the community learning disability nurse in the development of epilepsy care plans in the home. A good range of external support continues to be accessed by the home, including support by the community outreach team (community nurse, speech and language therapist, etc.). On the day of this inspection, staff taking a client to an appointment with a hospital consultant explained that this had been initiated following a health assessment by the community outreach team nurse when the client first came to live in the home. The manager felt that staff were quick to notice and respond to any healthcare needs. The home had appropriate equipment to meet individual needs (e.g. wheelchair, hoist, assisted bath, etc.). The home’s medication policy was not inspected on this occasion. No clients currently had the ability to administer their own medication. Medication continued to be safely stored in each part of the home; staff reported that the home also has a controlled drugs cabinet. Records were only viewed in the Annex on this occasion: pre-printed Medication Administration Records (MAR) were provided by the pharmacist, and the file containing the MAR included a current list of staff names (and signatures) responsible for administering, and photos of service users. Quantities of medication received by the home were recorded on the MAR, with entries signed and dated; medication carried over from a previous month was also being recorded on the MAR, although in a couple of cases this had not been signed by the person making the entry. Administration records were clearly maintained, with no gaps seen on the sample inspected, and codes consistently any used for non-administration of medication. In one instance administration instructions on the MAR were not complete (e.g. stated ‘take as directed when required’ but did not show the number of tablets to be taken), and staff should take every effort to ensure that medication records are accurate and signed. Medication training was not specifically inspected on this occasion, but training records provided showed that five of the six senior carers had attended medication training within the last two years (and one of the three bank senior carers). Assessment of competence to administer medication was not discussed. Grammar School House DS0000040901.V317520.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 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has procedures in place for ensuing that service users are listened to and their concerns acted on, and for promoting the safety and protection of service users. Although further action was required regarding POVA training, new training arrangements being implemented within the organisation should enable the provider to take action to manage the improvement required. EVIDENCE: On previous inspections it was noted that the home’s complaints procedure was included in the home’s statement of purpose and service user guide. This was not reviewed on this occasion. The manager confirmed that the home does not currently have any alternative formats for the complaints policy (or other policies), but stated that a pictorial version was being developed elsewhere in the organisation, and another home had a video version available that was to be implemented in all the provider’s homes. Action to introduce alternative formats should be progressed. The manager stated that the complaints procedure had been explained to a new client, and felt confidant that this person would be able to speak to staff about any concerns. Only a few clients had the ability to express their wishes and feelings verbally, but those spoken to were confident and outspoken, and appeared comfortable to speak easily with both the manager and the staff. Grammar School House DS0000040901.V317520.R01.S.doc Version 5.2 Page 18 No complaints had been received by the CSCI since the last inspection, and the manager reported that no new complaints had been received by the home. She confirmed that the home continues to maintain a standardised recording system for complaints, as seen on previous inspections. The home has a policy on the protection of vulnerable adults (POVA) and a procedure for responding to suspicion of abuse; this referred to reporting incidents to the person in charge/manager, the CSCI and to the POVA team at Social Services. The manager confirmed that POVA training was still mainly carried out in-house via a training video: a summary of staff training provided by the home indicated that not all staff had completed the in-house video training on adult abuse. The home must ensure that all staff have suitable and sufficient training in adult abuse awareness and procedures, and it is strongly recommended that the home provides other forms of POVA training to compliment and supplement the information provided by videos, and ensures that there are systems in place to check that staff understand adult abuse issues and procedures. Awareness of abuse issues was not specifically discussed with staff on this occasion. Grammar School House DS0000040901.V317520.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, 27, 28 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a comfortable and safe environment that is well maintained and kept clean and hygienic. Bedrooms and communal space promote service users’ independence. Bathrooms are equipped to meet the various needs in the home. EVIDENCE: On the day of the inspection, areas of the home viewed were clean, tidy and in a satisfactory state of decoration. Records of maintenance and decoration were not viewed on this occasion, but the home is commended for the progress made in refurbishing the Seven-side of the home following the last inspection. In particular, new flooring had been installed in the hallway and dining room, and the dining room had been redecorated and equipped with new tables and chairs; the lounge had been decorated and some pictures put on the walls; the bathroom had been redecorated and tiled and an assisted Grammar School House DS0000040901.V317520.R01.S.doc Version 5.2 Page 20 bath installed, and storage cabinets installed in the bathroom and toilet. The lounge area had greatly improved through painting the walls in a lighter colour, but still lacked a ‘homely’ feel: it is acknowledged that this is partly due to the shape of the room, but it is recommended that the home continues to explore ways of making this space more welcoming and comfortable (e.g. replacing the carpet which is dull and marked; new blinds; introducing more colour through cushions, etc.). Bedrooms viewed were bright, cheerful and well personalised. The home currently has one bathroom on each side of the home: as noted above, the bathroom on the Seven-side had been refurbished and provided an assisted bathing facility with hoist access; it had a lockable door to promote privacy. All bedrooms have hand washbasins, but only one bedroom (in the Annex) has an ensuite toilet. No action had been taken regarding providing an additional bathing facility on the Seven-side of the home: in view of the fact that all clients required regular assistance with personal care, it is recommended that this is given serious consideration. The Annex remained in a satisfactory state of decoration: the kitchen was due for refurbishment the week following the inspection (the Seven-side kitchen was refurbished last year), and the lounge was comfortable and homely. The room of a new client had been decorated prior to their admission, and was seen to provide them with good space and facilities. The manager stated that the home does not currently have a regular maintenance person, but a company maintenance person visits twice a month to carry out maintenance tasks, and the home can access other decorators and repair persons when required (for example, on the day of the inspection a heating engineer was visiting to address a boiler problem that had just occurred). The manager confirmed that previous outstanding jobs had now been completed. There had been no change to the home’s laundry facilities, which remained adequate for the home and included washing machines with a hot wash cycle (95°C), a sluice sink and a hand washbasin. A laundry protocol had been developed, and it was noted that hand soap, paper towels, and disposable gloves and aprons were available to staff. Infection control policies and procedures were not inspected on this occasion: it had been noted on a previous inspection that company policies and procedures covered this issue. Training records provided on the inspection (see next section) showed that only nine staff had received any specific infection control training (via an infection control training video, with three senior staff also attending outside training): it is recommended that all staff receive training in this subject. Grammar School House DS0000040901.V317520.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, and 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has an effective staff team, with sufficient staff on duty to meet service users’ needs. Recruitment processes supported and protected service users, and staff demonstrated appropriate qualities and attitudes. However, training and the level of qualification amongst the staff team was not currently satisfactory, and required further action. EVIDENCE: At the time of this inspection there were sufficient staff on duty to meet the needs of current clients. It was good to see that the number of staff on duty in the Annex during the day had been increased to ensure sufficient cover, in response to one client’s unpredictable behaviour. Staff reported that they found this increased staffing level had helped them to safely support clients. At nights there was now an additional sleep-in staff member when required. The manager stated that if necessary staffing could be provided flexibly to meet clients’ needs, and an evening activities person was employed for five hours a week. Although a couple of staff were off sick, there appeared to have been a Grammar School House DS0000040901.V317520.R01.S.doc Version 5.2 Page 22 low turn-over rate since the last inspection: four new staff had been recruited and although agency staff were sometimes used in the home, an agency carer spoken to during the inspection confirmed that they had worked at the home several times, and now knew the clients. The staff team reflected the gender composition of the clients, and staff spoken to showed a good understanding of their work, and a genuine care and interest in the clients. They were seen to be approachable, and appeared comfortable with the clients. Since the last inspection the staff had received some training in total communication and also in physical intervention: although this initial training needs to be developed further, this was a good start and had clearly benefited staff. One new staff member spoken to advised the inspector that they were ‘loving the job’, and that they had felt very welcome at the home and staff and manager had been very supportive. Of the 18 care staff employed at the home at the time of this inspection (excluding four bank carers and two activities staff), only six had completed NVQ level 2 or above (i.e. 33 ). This does not meet the Standard for the percentage of qualified staff working in the home: the manager advised that four more staff had signed up to start this training, and needs to progress action to ensure that more staff achieve this qualification. The files of two new staff were inspected for evidence of recruitment practices. Both contained application forms that included a complete employment history, names of referees, a criminal record declaration, and a health questionnaire. One criminal record declaration was not completed and the manager was advised to always ensure that applicants complete this section. Three references had been obtained in both cases, including a last employer reference: in one instance the most recent period of employment had been very brief, and it was recommended that a previous employer reference should have also been sought. Where a reference is followed up by a telephone call, the manager should ensure that the outcome of the call is clearly recorded. Both files contained evidence of a CRB check and also of a POVAfirst check obtained before the person started work; only one file contained evidence of the POVA check on the full CRB check, and the manager was advised to ensure that a POVA check is requested on the CRB application form. There was evidence that a TOPSS (Training Organisation for the Personal Social Services) induction programme had been used with both new staff: the manager was advised that this has now been replaced by the Skills for Care ‘Common Induction Standards’, and advised to obtain information on this. There had been no progress in implementing any Learning Disability Award Framework (LDAF) training within the home. Although several staff had completed a distance-learning course in food hygiene this year, and many had attended Total Communication and Physical Intervention workshops, the home was still relying heavily on training provided through videos. This was discussed again with the manager, who was advised Grammar School House DS0000040901.V317520.R01.S.doc Version 5.2 Page 23 that these provide useful supporting information and input, but for most subjects should not be used as the only form of training. A summary of staff training provided at the time of the inspection indicated that a number of staff did not have evidence of recent training in core subjects (fire safety, infection control, moving and handling, food hygiene, POVA, epilepsy awareness, etc.). The records of two staff members who had been in post six months indicated that the only training they had received in core subjects such as Moving and Handling, Fire Safety or POVA was through watching videos, and they had not received any training in epilepsy (which several current clients suffered with). The manager and area manager were aware that training was an area that needed addressing in the home. They advised the inspector that the new Learning Disability Directorate within the organisation has recently acquired a training company that will be providing or arranging all training in future, and expected this to make significant improvements in the access and provision of training for the home. The registered provider is reminded that each staff member should have an individual training and development assessment and profile, and at least five paid training days (pro rata) per year (reference Standard 25.5). Grammar School House DS0000040901.V317520.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 good. This judgement has been made using available evidence including a visit to this service. The manager is appropriately qualified and experienced to run the home. The home is run in the best interests of residents, with systems in place (and under development) for monitoring this. The home has policies and systems in place to promote the health and safety of residents and staff: although action is required relating to the checking of fire equipment and the recording of fire drills, based on past evidence the CSCI is confidant that the provider will take action to manage the improvement required. EVIDENCE: The registered manager has appropriate experience to manage the home: she attends relevant training as required, has previously completed NVQ level 4 in management, and is currently undergoing the Registered Manager’s Award and additional units to attain NVQ level 4 in care. She is key worker to one Grammar School House DS0000040901.V317520.R01.S.doc Version 5.2 Page 25 client and is actively involved in the running of the home, including working regular shifts alongside care staff. Staff spoken to were very positive about the manager, describing her as approachable and supportive, always there for them, and willing to listen to suggestions. The organisation has a quality assurance department that is responsible for implementing quality assurance processes, including sending out survey forms to clients and staff and evaluating the responses. The manager stated that a staff survey had been carried out in January 2006, and the feedback had been positive. A survey had been sent out to relatives at the end of May 2006, but the manager had not yet received any feedback on the outcome of this. The manager had carried out an audit on the home earlier in the year: the outcome of this was not inspected on this occasion. Very few clients are currently able to express their views on the quality of care in the home, and there not at present any formal systems for evaluating the quality of care in relation to clients who cannot provide verbal feedback. However, the area manager advised that the organisation was in the process of making arrangements with the British Institute for Learning Disabilities (BILD) to look at a process focusing on outcomes for clients. Annual development plans and other forms of internal auditing were not inspected on this occasion. The home had an appropriate Health and Safety policy, and the manager advised that the home had a range of other health and safety information and guidance that was available to staff and gone through at induction. Staff training in health and safety issues has been commented on in the previous section. The manager maintained records of all checks and servicing carried out on equipment and utilities, and the sample viewed provided evidence that the equipment and premises were regularly maintained. Records showed that hot tap water temperatures were checked weekly, and the home had a Legionella policy and Risk Assessment: whilst it was noted that showerheads were disinfected earlier in the year, there was no evidence of other systems in place to monitor and prevent risk of Legionella (e.g. checking of central hot and cold water storage temperatures). There was evidence of the regular testing of fire alarms, but the testing of emergency lighting and the checking of fire equipment had not been recorded over the previous six months. Two fire drills had been recorded this year, but there was no evidence of the names of the staff that had attended these drills. The home had a fire risk assessment and a range of other risk assessments on relevant safe working practices. Accident records were not inspected on this occasion. Grammar School House DS0000040901.V317520.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 3 4 3 5 X 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 3 25 X 26 X 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 3 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 2 X Grammar School House DS0000040901.V317520.R01.S.doc Version 5.2 Page 27 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 YA23 Regulation 13 Requirement Timescale for action 28/02/07 2 YA35 18 3 YA42 4 YA42 23(4) and 17, schedule 4.14 23(4) The registered person must ensure that all staff receive suitable and sufficient training in adult abuse awareness and procedures. The registered person must 31/03/07 ensure that all staff have attended suitable and sufficient training in all key subjects relevant to the clients being cared for in the home, including training in health and safety issues. The registered person must 30/11/06 ensure there is evidence of the regular testing/checking of all fire equipment. The registered person must 30/11/06 ensure (and demonstrate), by means of fire drills and practices, that persons working in the care home are aware of the procedure to be followed in the case of fire. This particularly relates to recording the names of staff attending fire drills, and ensuring all staff attend these at suitable intervals. Grammar School House DS0000040901.V317520.R01.S.doc Version 5.2 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 2 Refer to Standard YA2 YA6 Good Practice Recommendations It is recommended that pre-admission visits to the home by prospective clients be recorded as part of the preadmission assessment process. It is recommended that the home explore alternative formats for care plans, to promote greater involvement by service users in the development and review of their care plans (e.g. pictorial versions, audio, video, etc.) It is recommended that the home continues to develop care plans, to ensure that they address service users’ hopes and aspirations as well as their daily needs. The registered person should identify sources of advocacy support for service users. Staff should take every effort to ensure that medication records are accurate and signed by the person making the record. It is strongly recommended that the home consider providing an additional bathing facility in the home. The registered person should progress action to ensure that sufficient staff in the home are appropriately qualified. The registered person should ensure that the type of training provided ensures that staff achieve the required knowledge and competency. This is with regard to the reliance on video training formats for many core subjects in the home. The registered person should ensure that the home’s induction process meets reflects the Common Induction Standards developed by Skills for Care. The registered person should ensures that staff receive ongoing training to provide them with the skills to meet and develop the various communication needs of service users within the home. It is recommended that LDAF training be implemented within the home as soon as possible. The registered person should ensure that there are systems in place to monitor and prevent risk of Legionella (e.g. checking of central hot and cold water storage temperatures, etc.). 3 4 5 6 7 8 YA6 YA7 YA20 YA27 YA32 YA35 9 10 YA35 YA35 11 12 YA35 YA42 Grammar School House DS0000040901.V317520.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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 Grammar School House DS0000040901.V317520.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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