Inspection on 17/05/07 for Granary The

This inspection was carried out on 17th May 2007.

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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 24 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Granary The 06/11/07

Granary The 24/11/05

Granary The 13/06/05

Granary The 04/11/04

Granary The 07/06/04

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

The Cornerstone

John Street Nursing Home

Pennine Camphill

Whitwood House

Whitwood Hall

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

CARE HOME ADULTS 18-65 Granary The Church Lane Brandesburton Driffield East Yorkshire YO25 8QZ Lead Inspector Christina Bettison Key Unannounced Inspection 17th May 2007 09:30 DS0000019742.V340597.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 DS0000019742.V340597.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. DS0000019742.V340597.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Granary The Address Church Lane Brandesburton Driffield East Yorkshire YO25 8QZ 01964 543332 01964 543332 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) Milbury Care Services Limited Jacinta Murray Care Home 15 Category(ies) of Learning disability (12), Learning disability over registration, with number 65 years of age (4) of places DS0000019742.V340597.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC; To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD and LD (E) The maximum number of service users who can be accommodated is: 12 Category LD (E) relates only to named service users identified to the Commission for Social Care Inspection on 18.9.2006. 24th November 2005 2. 3. Date of last inspection Brief Description of the Service: The Granary is a care home providing accommodation and care for up to 12 adults with learning disabilities. It is located in the village of Brandesburton. It is a short walk into the village and allows access to hairdressers, shops, post office, pubs and a fish and chip shop. The main road through the village allows access to public transport. The home was opened in 1990. There are 12 single bedrooms, three of which have en-suite facilities. The home has a wellmaintained front garden and is surrounded on two sides by fields. Garden furniture is available for service users to sit outside. All bedrooms are for single occupancy. Weekly fees are: £680 - £985 per person. Additional charges are made for the following: newspapers/magazines, hairdressing, chiropody, transport for social activities and sweets. Information on the service is made available to current service users via the statement of purpose, service user guide and inspection report. DS0000019742.V340597.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an unannounced key inspection and took place over 1 day in May 2007. Relative surveys were posted out of which 4 were returned, 1 visiting professional survey was returned and 6 staff surveys were returned. 12 easy read service user surveys were left at the home on the day of inspection, of which 8 were returned. Six staff surveys were returned and in five of these staff commented that more staff would improve the standard of the service to the service users and improve their quality of life. During the visit the inspectors spoke to the manager, staff, and service users and observed the interactions between staff and service users to find out how the home was run and if the people who lived there were satisfied with the care and facilities provided. The inspector looked around the home and looked at some records. Information received by us over the last twelve months was considered in forming a judgement. Prior to the visit the inspector referred to notifications sent to the Commission for Social Care Inspection, the event history for the home over the past year and the completed pre-inspection questionnaire. The site visit was led by Regulation Inspector Mrs T Bettison, the visit lasted 9 hours. This was the first time the inspector had visited this service. What the service does well: Service users and their relatives are provided with information that is easy to read so that they know what to expect from the home. All service users have a single room that is nicely personalised to their own taste, providing them with a private area to their liking where they can spend private time or receive visitors. Relatives are very involved in the home and are made to feel welcome, making sure that family can keep in contact. A good recruitment policy is in place so that service users are protected from harm. Service users are happy living at the home, two service users completed the survey themselves and commented “I like the granary, I like the staff, I like the residents, I like living here, I like the new TV, walk into the village, talk DS0000019742.V340597.R01.S.doc Version 5.2 Page 6 and joke with laughs, snooker or pool, I like the Riverhead Centre, work on flowers and life skills” and another commented “ I go to church, I go for walks, I visit friends, I go out for meals, I watch TV, I like to knit”. One relative commented “my experience from the beginning has made us deeply grateful for its location and amenities, the devotion of management and staff over the years and the happy atmosphere they have maintained”. Another commented “although ….. has only been at The Granary for a short time, I have always found the staff most helpful and accommodating. As for the rest of the house his room is clean and nicely furnished”. What has improved since the last inspection? What they could do better: Most of the service users have lived in the home for a number of years and have been cared for by the same group of staff. The way in which people have been cared for has changed very little over time. The new manager and the company have recognised that they need to change in a number of ways, which has started. The changes that are being talked about as being needs would mean service users being provided with more modern care and be helped to take more control over their lives. The guide for service users needs be changed so that it says clearly what service users can expect from the home and when new people move into the home the manager needs to be sure that their needs can be met. To make this change happen will mean a lot more work such as more detailed service user plans and where service users are at risk of harm it will be clearer how this will be reduced. Service users religious and cultural needs and activities and interests will need to be included in the plans. Also there will need to be plans to identify and say how service users health needs will be met. DS0000019742.V340597.R01.S.doc Version 5.2 Page 7 Staff will need basic training and extra training to help them understand what is expected of them. When service users have medicines that are taken “when needed” the instructions for staff need to be clear when and why they can help service users to take it. There needs to be enough staff in the home so that the staff can meet the needs of service users and carry out all of their duties safely. These are just some examples of what is needed. 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. DS0000019742.V340597.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 DS0000019742.V340597.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 4 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users needs are assessed prior to admission, information given may be misleading and consideration is not being given as whether the home is sufficiently resourced to meet their needs. EVIDENCE: The home has a statement of purpose and a service users guide, and service users and their representatives are provided with information about the home, however, as detailed within this report the home are not providing everything that is detailed in the service guide and therefore it must be reviewed and amended to accurately reflect the service provided. There have been two new admissions to the home since the previous inspection. Both service users had a copy of the community care assessment and Local Authority care plan on file. In addition to this the home had completed their own assessment. DS0000019742.V340597.R01.S.doc Version 5.2 Page 10 However, not all of the assessed needs have been developed into detailed service user plans, both of the service users present with communication deficits and behaviour that can be difficult to manage and pose a risk to themselves and others and there were no detailed risk assessments and management strategies in place. In addition to this, consideration has not been given as to whether the home is sufficiently resourced to meet all of the service users needs. Both of the new admissions were placed as emergency placements therefore Milbury and Voyage had little control over the arrangements for introduction to the new service. Service users were able to take advantage of trial visits but not overnight stays due to the urgency of both placements. The home manager, having reviewed the staffing arrangements following their admission, has written to the responsible individual requesting additional staffing resources to ensure that all of the service users needs can be met, at the time of the inspection visit she had not had a response. In addition to this, on examination of the service user financial records, it appeared that service users were paying for their own holidays, however, in discussion with managers they confirmed that all service users are funded up to £200 towards the cost of a 5 day holiday or a series of one day outings by the organisation as part of the contract price. It states in the home’s own Service User Guide “Milbury will pay the costs and staffing for one 5-day holiday per year or 5 day outings”, however, it does not specify the amount, the service user guide needs to be amended to accurately reflect what happens in practice. It was noted from the financial records and stated in the service user agreements that service users will pay a contribution towards the use of the home vehicle. The manager needs to ensure that this is an equitable arrangement as some service users don’t use the transport and some use it more than others. Where service users are expected to contribute towards the use of the vehicle this needs to be clearly stated in the service user guide and/or the statement of terms and conditions so that prospective service users and/or their representatives are aware of the cost of using the homes transport and are in agreement with it. DS0000019742.V340597.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 People who use the service experience poor outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users needs are met on an informal basis by inadequate numbers of staff, the quality of the service user plans and risk assessments are very basic. These shortfalls have the potential to place people at risk and mean that service users assessed needs are not met. EVIDENCE: All service users have a care file, which are all in the process of being updated and transferred into the new corporate format. Six care files were examined as part of the inspection process. The service user plans did not include everything that is detailed in the Local Authority assessment/care plan, they did not reflect the full range of needs and do not ensure that all aspects of health, personal and social care needs are identified DS0000019742.V340597.R01.S.doc Version 5.2 Page 12 and planned for and did not detail accurately what staff need to do to meet service users needs. In one care file examined for a new service user admitted on 16/3/07 there was a very basic service user plan that did not cover all identified needs and there were no risk assessments completed. In this service users CCA/Care plan completed by the Local Authority it detailed a service user with significant care and support needs, dislocated hips, left side hemiplegia, dry skin condition, assistance to take all medication, prone to ear infections and has hearing problems, support with bathing and personal care, prompting for dressing and use of the toilet, help with domestic tasks, support outside for safety, all food to be cut up and prone to both verbal and physical outbursts. The service user plan consisted of basic needs recorded under health, stating that the service user had a dry skin condition, allergy to antibiotics and hearing problems, but no detail as to how these needs would be met by staff or health provision. The personal care section simply stated “assistance to shower back and hair washing”, no detail given as what the service user can do themselves and what staff need to do to support them. There was a small section on family contact and a section stating that the service user had difficulties with their mood and anxiety, however, all of this was very basic. This service user had had an initial review attended by the LA on 21/03/07. Areas of health needs had not been sufficiently detailed either in the service user plan and there has been no input from the Health Authority/Community Team Learning Disability in the development of health screening or health action plan and there was no evidence of outcomes of monitoring of health needs, however, managers confirmed that they have been involved with “Learning Disability Partnership Board” and this work is due to commence soon. This is detailed further in the health section of this report. Where service users display behaviours that can be difficult to manage and specific techniques or methods of communication are needed in order to minimise the risks there were behaviour management strategies completed by the Health Authority, however, the home had not completed their own and there were no protocols in place for the administration of medication on a PRN basis. In another care file examined for a service user admitted on 07/05/07 there was no service user plan, and although there were risk assessments in the file the inspector was informed that they had been forwarded from their previous placement. As detailed in the CCA/Care plan this service user is autistic, has behaviour that can be difficult to manage, no verbal communication, full support for bathing, a left sided weakness, assistance with dressing and managing DS0000019742.V340597.R01.S.doc Version 5.2 Page 13 continence issues, needs assistance to shave, help with domestic tasks, has no road safety skills or sense of danger, and needs all food cutting up. Once again areas of health needs had not been detailed either in the form of a service user plan or health action plan and there was no evidence of outcomes or monitoring of health needs; again this is detailed further in the health section of this report. In the third care file examined (a service user that has lived in the home since November 2004) again there was no service user plan and only one risk assessment relating to the service user locking his door and staff not being able to gain access in an emergency. This service users LA CCA/care plan details he is an early riser, prefers a bath, likes company, has no road sense, has communication deficits, wears glasses and needs assistance with continence issues, although none of their needs were detailed in a service user plan. In this file there was no evidence of reviews having taken place. There were serious omissions in all the care files examined, poor or no service user plans detailing all needs and including areas of cultural and religious needs, diet and nutrition, communication needs, mobility issues, no risk assessments, behaviour management guidelines did not include administration of medication PRN, no systematic monitoring of incidents of presenting behaviour, no health action plans and lack of health provision and support. Discussion with staff suggested that service users basic care needs were being met even though there was a lack of clear plans and guidance. This approach is dependent on staff memory and good verbal communication systems. Service users are at risk of not having their care needs met if these informal systems break down. The manager had been undertaking some review and monitoring of the care files, however, she had focused her attention on other parts of the service that were seen as higher priority, therefore, service users plans at the time of inspection had remained basic. Whilst these have been acceptable for several years it is agreed by all that it is now time to make these more person centered and purposeful. In 3 service user surveys returned service users commented that they were only involved in decision making within the home sometimes and there was no evidence of any advocacy input. DS0000019742.V340597.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12, 13, 14, 15, 16 and 17 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. A limited range of activities within the home and community and poor record keeping does not evidence that service users have the opportunity to maintain and develop their skills and participate in stimulating and motivating activities that meet their individual needs, wants and aspirations. EVIDENCE: Service users are being provided with a range of activities, both in-house and within the community, however, there were little or no supporting documentation to evidence that service users needs in this area had been identified, planned for and therefore met. Service users who are independent lead a more active lifestyle, however, those less able or needing staff support, DS0000019742.V340597.R01.S.doc Version 5.2 Page 15 activities tend to be based around attendance at day services and local village amenities. Two more able service users completed the survey themselves and commented “I like the granary, I like the staff, I like the residents, I like living here, I like the new TV, walk into the village, talk and joke with laughs, snooker or pool, I like the Riverhead Centre, work on flowers and life skills” and another commented “I go to church, I go for walks, I visit friends, I go out for meals, I watch TV, I like to knit”. There are six service users that live in Brands Lodge, a converted barn at the rear of the main house. Two of the service users live semi independently. Those service users spoken to lead an active lifestyle, one of the service users has a dog and takes it out regularly for walks, she informed the inspector that she visits friends, chats to people in the village and enters her dog for dog shows which she thoroughly enjoys. She stated that she was very happy living at the granary and that she gets on very well with the other lady that she shares the house with. They both have a single bedroom and separate lounges and only share the kitchen and bathroom. The other service user living there looks after the manager’s dog during the day and she and the other service user take them out for walks together. She told the inspector that she enjoys working on her tapestry and watching TV. The other 6 service users live in the main house and require more staff support. In one of the care files examined, there was an activities programme completed in a person centred format and detailed that the service user attended Grovehill Day Service 2 x weekly, spends time tidying his room, going for walks, watching films and TV. His mum and dad visit him on Saturday morning. In another file examined the service user attends the day service at Sowerby 2 x weekly, but no other areas of interests or activities were detailed. In the third care file examined there was no detail of activities undertaken. One of the service users at home on the day of the visit was able to tell the inspector how he likes to do pencil drawings and that a lady comes into the home once week to take an Art class which he enjoyed. The service users that take part in this class pay for it. The inspector was informed by the staff that the home organises trips in the summer to Blackpool and Flamingo Land, and that they hold birthday parties and discos in the local village hall. They attend the Floral Hall for musicals and service users enjoy going to McDonalds. There is a large TV in the lounge and DS0000019742.V340597.R01.S.doc Version 5.2 Page 16 service users enjoy film nights and there is also a pool table that service users were observed using. There was evidence in the service users meeting minutes that service users are enabled to make choices about trips and choosing new carpets for the home and where to go on holidays and who with. However, there was very little information on care files as to how the home are enabling service users to maintain and/or develop new skills and how their interest and/or hobbies are being supported and a lack of records of activities undertaken. Discussion with staff and records indicated that family and friends are able to visit the home and can use any of the communal facilities or the service users bedroom. There is no restriction on visiting times. Staff assist service users to maintain contact via mail and telephone. The majority of service users have limited verbal communication to express their choices and wishes and promote their independence. Any restrictions are not documented within their service user plan. The care staff currently do all of the shopping and cooking and the evening meal on the day of the visit was curry. The home promote a healthy eating menu which consists of choice of cereals and toast for breakfast and occasionally crumpets, porridge or a full cooked breakfast on a Sunday, sandwiches, soup and something on toast for lunches and the evening meal is a cooked meal consisting of curries, casseroles, pizza, salads, pasta and a full roast dinner on a Sunday. The menu contained fresh vegetables and fruit salsa and yoghurts and appeared to be a varied diet with some scope for likes and dislikes. However, the diet and nutritional needs of service users needs to be detailed in service users plan and include their likes and dislikes. DS0000019742.V340597.R01.S.doc Version 5.2 Page 17 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 poor. This judgement has been made from evidence gathered both during and before the visit to this service. Service user’s health and personal care needs are not being fully identified, planned and met. These shortfalls have the potential to place residents at risk. EVIDENCE: Service users plans and supporting documents are very basic. There has been no health screening undertaken by the community nurse and none of the service users had a health action plan or a detailed service user plan relating to health needs. Therefore health needs are not being clearly identified or planned for. Currently the local GP makes sure that service user medication reviews take place but no record of this is maintained in the home. There was evidence that staff do consult with health professionals i.e. GP, physiotherapy, dentist, chiropody and psychiatry etc, but the recording was very poor and although dates had been recorded when service users had visited the dentist, GP etc the records did not evidence outcomes for service users in respect of meeting their health needs. DS0000019742.V340597.R01.S.doc Version 5.2 Page 18 In one care file examined there was a very basic service user plan that did not cover all identified needs and there were no risk assessments completed. In this service users LA CCA/Care plan completed by the Local Authority it detailed a service user with significant health, care and support needs, dislocated hips, left side hemiplegia, dry skin condition, assistance to take all medication, prone to ear infections and has hearing problems, support with bathing and personal care, prompting for dressing and use of the toilet, help with domestic tasks, support outside for safety, all food to be cut up and prone to both verbal and physical outbursts. The service user plan consisted of basic needs recorded under health, stating that the service user had a dry skin condition, allergy to antibiotics and hearing problems, but no detail as to how these needs would be met by staff or health provision. As detailed in the LA CCA/Care plan this service user is autistic, has behaviour that can be difficult to manage, no verbal communication, full support for bathing, a left sided weakness, assistance with dressing and managing continence issues, needs assistance to shave, help with domestic tasks, has no road safety skills or sense of danger, and needs all food cutting up. Once again areas of health needs had not been detailed either in the form of a service user plan or health action plan and there was no evidence of outcomes or monitoring of health needs. In general the medication appeared to be well managed and one of the senior care officers had overall responsibility for its management. The home stored medication securely. Pharmacy support was from the Leven Pharmacy attached to the surgery. The senior staff had completed administration of medication training, however, they had not had their competency assessed. Senior staff confirmed that they had completed epilepsy management training, which included the administration of rectal diazepam. All medication was signed into the home and there were no missed signatures on the medication administration records observed. Stock control was managed and medication was returned to the pharmacy when no longer in use. There have been three deaths in the home since the previous inspection, two of the service were in the older age category (70’s) and one was younger (40’s). All three care files were examined as part of the inspection, two of the service users had died in hospital following admission and the other died in the home, DS0000019742.V340597.R01.S.doc Version 5.2 Page 19 supported by district nursing service. There was a nursing care plan in place and a pain management plan. However, for all 3 care files the homes records were poor and as stated above all service users needed to have had health screening, and health action plans in place that would have ensured their health needs were identified, planned for and met in a timely manner. DS0000019742.V340597.R01.S.doc Version 5.2 Page 20 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 poor. This judgement has been made from evidence gathered both during and before the visit to this service. The home has a complaints system however not all relatives are aware of it and verbal complaints from service users are not being recorded appropriately and due to the unsatisfactory staffing arrangements, poor service user plans, and lack of training service users are not protected from harm whilst in the care home. EVIDENCE: The home has a complaints procedure and policies and procedures for safeguarding adults. There was evidence in the service user meeting minutes that service user dissatisfaction is raised and dealt with, however, this appears to be service users with verbal communication skills that dominate and it is unclear as to what mechanisms are in place for enabling service users with poor communication skills to contribute. There had been no complaints to the home since the previous inspection, however, out of 6 returned surveys to the CSCI from relatives 4 of them stated that they were not aware of the homes complaints procedure, however, a recent QA audit completed by the home suggested that relatives did know the complaints procedure. There had been a number of compliments; after a meeting held at the home a group of professionals complimented the staff and the home and thanked them for their hospitality, a relative thanked the staff DS0000019742.V340597.R01.S.doc Version 5.2 Page 21 for hosting her son’s 50th birthday party and another relative commented how friendly and kind the staff are and how homely The Granary is. Two of the service users present behaviour that may pose a risk to themselves and others and none of the staff files examined evidenced that staff have received training in how to manage service users in times of distress and high anxiety. In the service user meeting minutes dated 17/6/06 it was noted, “all service users agreed to contribute towards the staff meal”, this must be looked into to determine if service user have or are paying for staff meals when they go out, as this is clearly unacceptable practice. In addition to this, on examination of the service user financial records, it appeared that service users were paying for their own holidays, however, in discussion with managers they confirmed that all service users are funded up to £200 towards the cost of a 5 day holiday or a series of one day outings by the organisation as part of the contract price. It states in the homes own Service User guide “Milbury will pay the costs and staffing for one 5-day holiday per year or 5 day outings”, however, it does not specify the amount, the service user guide needs to be amended to accurately reflect what happens in practice. It was noted from the financial records and stated in the service user agreements that service users will pay a contribution towards the use of the home vehicle. The manager needs to ensure that this is an equitable arrangement as some service users don’t use the transport and some use it more than others. Where service users are expected to contribute towards the use of the vehicle this needs to be clearly stated in the service user guide and /or the statement of terms and conditions so that prospective service users and/or their representatives are aware of the cost of using the homes transport and are in agreement with it. There were records to evidence that the manager and some staff had received training in the Protection Of Vulnerable Adults (POVA) but not all. The location of the home, the service being provided in two separate houses, the unsatisfactory staffing arrangements, poor quality and lack of service user plans, poor attention to health needs and outcomes and inappropriate financial practices means that service users are not protected from harm and/or exploitation whilst in the care home. (These areas are explained further in environment, management and staffing) and give cause for concern. DS0000019742.V340597.R01.S.doc Version 5.2 Page 22 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 and 30 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The environment provides service users with comfortable surroundings in which to live, however areas of the houses are shabby and in need of repair and redecoration. EVIDENCE: The Granary is set in the village of Brandsburton a few miles from Driffield in the East Riding of Yorkshire. The village has pubs, a social club, church and parish hall, shops, hairdressers, bowls, football and cricket clubs. The accommodation comprises of two buildings, the main house and a converted barn, which has been named “Brandes Lodge”. The main house comprises of a large lounge, dining room, kitchen, staff office, two bathrooms, utility room and 6 bedrooms. DS0000019742.V340597.R01.S.doc Version 5.2 Page 23 Brandes Lodge consists of 6 bedrooms, kitchen, lounge, conservatory and a separate large activity room and manager’s office. All service users have a single room that is nicely personalised to their own taste, providing them with a private area to their liking where they can spend private time or receive visitors. The inspector was informed that there had been some improvements made to the main house since the previous inspection, new carpets have been fitted in the entrance, lounge, stairs, hallway and dining room. They have purchased a large TV for the main lounge. Part of the main building has been reroofed as they have had a leak. A new boiler has been installed in Brandes lodge. However, there are parts of the main building that still look very shabby and dated. There is wallpaper half stripped off on the upstairs landing and although some bedrooms have been decorated, some of the others are looking tired and dated. Brandes Lodge, in comparison to the main house, appears run down and neglected. A requirement was made at the previous inspection to make good the windows as there is paint peeling off and they look as if they need replacing, however, this has not been attended to and remains an outstanding requirement. The whole of Brandes Lodge could do with a refurbishment and redecoration programme. Outside the houses there is a lovely walled garden giving service users the opportunity to sit outside and still have privacy. The garden furniture was out for the summer. DS0000019742.V340597.R01.S.doc Version 5.2 Page 24 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, 36 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The current staffing arrangements are not sufficient to meet the needs of the service users and specialised training is unsatisfactory placing service user at risk. EVIDENCE: The inspector was informed that the home has 16 staff in total, comprising of • • • • 1x 3x 6x 6x Registered manager senior support workers day support workers night support workers The rota evidenced that there are 3.5 support workers allocated per day shift, .5 of this is the registered manager and 1 x staff is the senior support worker, leaving only 2 x support workers to attend the needs of 10 service users (2 service users being reasonably independent but need some guidance and support). DS0000019742.V340597.R01.S.doc Version 5.2 Page 25 Staff have the responsibility of cleaning 12 bedrooms, 8 bathrooms and all communal areas, the preparation, cooking and serving and cleaning up after 3 meals per day, supporting service user to attend appointments, activities, undertake shopping and gardening and in addition to this attend to the care needs of service users. Six staff surveys were returned and in five of these staff commented that more staff would improve the standard of the service to the service users and improve their quality of lives. One relative commented “my experience from the beginning has made us deeply grateful for its location and amenities, the devotion of management and staff over the years and the happy atmosphere they have maintained” Another commented “although ….. has only been at the granary for a short time, I have always found the staff most helpful and accommodating. As for the rest of the house his room is clean and nicely furnished”. 8 staff files and the training records were examined in the course of the inspection, 3 of these being new starters. All had completed application forms, had 2 satisfactory references and CRB clearances prior to commencing employment. Two of the staff had started their probationary interviews and basic induction, however, one of them, a bank staff who had commenced on 26/03/07, had not started her probation or induction and had not had any basic fire safety induction. The managers reported that this is problematic when they are bank staff and not working regular hours. Some work to improve induction is underway. The manager must ensure that new staff are given basic induction into the home on commencement and commence LDAF induction and complete within 6 weeks of commencing employment and that Milbury’s policy and procedure regarding probationary periods are followed. The majority of staff were up to date with mandatory training and the three seniors had had safe handling of medication training in 2003, however, this had not been updated since and no assessment of competence undertaken. The home had a training plan and 1 x senior support worker has NVQ level 3 and 1 x senior support worker and 3 support workers have NVQ level 2. However, service users have presenting needs in communication deficits, autism, sensory impairments and present behaviours that may pose a risk to themselves or others, not all of the staff had received updated training in these areas. The inspector was informed that a pilot scheme had been introduced in January 2007 using the Elbox electronic system. The pilot scheme was DS0000019742.V340597.R01.S.doc Version 5.2 Page 26 successful and all staff will now be using this method to update some of their mandatory training and complete NVQ and LDAF. Staff records examined evidenced that supervision is provided sufficiently to ensure staff are adequately supported. In addition to this staff had received appraisal interviews. The registered person is required to review the staffing structure and care staff hours provided in the home to ensure that they can meet the complex needs of the service users and to ensure that at least 50 of staff are qualified to NVQ level 2. The registered person is also required to ensure that service specific training is provided in autism, effective communication skills, managing behaviour that may pose a risk to themselves or others, medication training that includes a competency assessment, safeguarding adults, equality and diversity, values and attitudes and effective recording. DS0000019742.V340597.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The management and conduct of the home is satisfactory however the scale of the task has meant that progress is slow. EVIDENCE: The Granary is part of Milbury Care Services which is a national provider of care and support services for people with a learning disability. Milbury is part of the Paragon Health Care group, which is a UK wide organisation that specialises in providing a range of services to vulnerable people. DS0000019742.V340597.R01.S.doc Version 5.2 Page 28 The registered manager of the service has over 25 years experience in the field of learning disabilities and has been in post since May 2006. She has a degree in social sciences and informed the inspector that she will commence her NVQ level 4 and registered managers award this year. The manager is registered with the CSCI. The manager confirmed that when she had taken over from the previous manager there were significant areas for improvement identified within the home. The inspector was informed that the registered manager and the staff team had been working very hard over the recent year to change institutional trends within the home and enable service users to be more independent and lead a lifestyle of their choosing. To bring about these changes is not easy and is taking some time. A health professional commented “The Granary is now under new management and I am impressed with her attempts at making small changes to eliminate the institutional trends” and another stated “since the new manager started there has been a change of attitude and things are now more positive, however, in the past it has been a very traditional service”. However, the lack of detailed service user plans and guidelines, poor attention to providing service specific training and lack of evidence that risk is being managed effectively does not ensure that service users are being protected from harm. Incidences of behaviour management are not being appropriately recorded and monitored and no action has been taken to address this. The restrictions of the current staffing structure and number of provided within the home mean that although the staff are willing they do not have the time within the shift to undertake all of required to ensure that service users complex personal, health needs are met. care and the and hours caring duties safety Staff have meetings with the managers on a regular basis and everyone is encouraged to join in with discussions and voice their opinions. As part of the inspection all maintenance records were examined;• • • • • Fire risk assessment- completed on 09/07/06 Fire drills- undertaken monthly Fire equipment checks- undertaken monthly Emergency lighting- undertaken monthly Gas safety- checked on 17/08/06 DS0000019742.V340597.R01.S.doc Version 5.2 Page 29 • • • • Electrical hard wiring- dated 06/02/06 valid for 5 years PAT –tested 02/10/06 Water temperatures- checked regularly Legionella – the home had file however no tests had been undertaken for over a year, the manager has raised this with H/Q. Milbury care services have a QA system, which includes regular audits and monitoring of the service culminating in an annual service review. The area manager undertakes regulation 26 visit on a monthly basis, this and the QA monitoring and checking process has highlighted the areas for improvement and the CSCI are satisfied that the home will make progress to ensure all requirements are met within the timescales specified. DS0000019742.V340597.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 2 3 x 4 2 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 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 2 32 1 33 1 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 1 x 1 x LIFESTYLES Standard No Score 11 2 12 2 13 2 14 2 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 1 2 x 2 x 3 x x 2 x DS0000019742.V340597.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA1 Regulation 5 (1) Requirement The registered person must review and amend the service users guide to ensure that it accurately reflects the service provided. The registered person must ensure that the assessment of service users is kept under review and service users must not be admitted if the home are unable to meet their assessed needs. The registered person must ensure that service users admitted in an emergency have an up to date service user plan and risk assessments within 5 days of admission. The registered person must ensure that service user plans are developed and agreed with service users and must detail the action to be taken by staff to meet their personal, health and welfare needs. The registered person must ensure that service users are reviewed at least 6 monthly and plans are updated to reflect changing needs. DS0000019742.V340597.R01.S.doc Timescale for action 31/08/07 2 YA2 14 30/06/07 3 YA4 13, 15 30/06/07 4 YA6 15 and 17 31/08/07 5 YA6 15 and 17 31/08/07 Version 5.2 Page 32 6 YA7 13 (6 and 7) 7 YA9 13 and 17 8 YA11 16 (3) 9 YA12 YA13 YA14 16 (2 m and n) 10 YA19 13 11 YA20 13 and 15 12 YA20 13 and 15 13 YA22 22 The registered must ensure that where service users display behaviours that are difficult to manage or there are any limitations or restrictions on facilities, choice or human rights to prevent self harm or abuse or harm to others that this is agreed by a multi agency meeting and documented appropriately. The registered person must ensure that there are individual and generic risk assessments available that are maintained and reviewed. The registered person must ensure that service users religious and cultural needs are identified planned for and met. The Registered person must ensure that activities are identified, planned for and provided that meet the diverse needs of the service users and meet their assessed needs. These must be incorporated into the service user plan. The registered person must ensure that service users complex health needs are met by the provision of health screening, health action plans and access to health professionals. The registered person must ensure that where medications are administered PRN that guidelines for administration are written up and followed by staff. The registered person must ensure that staff have received training the management of medication and that they are assessed as competent. The registered person must ensure that relatives are aware of the homes complaints DS0000019742.V340597.R01.S.doc 31/08/07 31/08/07 31/08/07 31/08/07 31/08/07 30/06/07 31/08/07 30/06/07 Version 5.2 Page 33 14 YA23 13 (2 6) 15 YA23 13 (2 6) 16 YA24 23 17 YA32 18 18 YA32 18 19 YA33 18 procedure and that strategies are put in place to enable all service users to raise areas of concerns. The registered person must ensure that all staff receive training in safeguarding adults and that all requirements are met to ensure service users are protected from harm. The registered person must review the arrangements for the payment of holidays, payment of transport and payment for staff meals and ensure that this is accurately reflected in the service user agreements/service user guide and/or statement of terms and conditions to ensure that service users are not at risk of financial exploitation. The registered person must provide a maintenance and renewal plan with timescales for the redecoration of the interior of the house and the renewal or repair and painting of the windows in the barn. (Timescale of 28/02/06 not met) The registered person must ensure that all new staff are registered on and complete induction to LDAF standards within 6 weeks of appointment. The registered person must ensure that staff receives specialised training in meeting the complex needs of service users with a learning disability;• Autism • Communication skills • How to deal with service users that present with difficult behaviour • Equality and diversity • Safeguarding adults The registered person must ensure that the home has an DS0000019742.V340597.R01.S.doc 31/08/07 30/06/07 30/06/07 30/06/07 31/08/07 31/08/07 Version 5.2 Page 34 20 YA34 18 21 YA37 8 22 YA42 23 effective staff team with sufficient numbers and skills to support service users assessed needs at all times. Staffing levels must be regularly reviewed to reflect service users changing needs. The registered person must ensure that new staff are subject to probationary periods and written evidence available that regular reviews have taken place. The registered person must ensure that the home is managed effectively. Policies and procedures are implemented and that compliance with the care standards act, regulations and other legal requirements are adhered to. The registered person must ensure that the home is safe and that there is evidence that the risk of the Legionella bacteria is minimised and that staff are up to date with their mandatory training. 30/06/07 30/06/07 31/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA37 YA32 Good Practice Recommendations The registered person should ensure that the registered manager is qualified to NVQ level 4 and completes the registered managers award. The registered person must ensure that at least 50 of staff are qualified to NVQ level 2 DS0000019742.V340597.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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 DS0000019742.V340597.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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