Inspection on 09/05/06 for Haddon (32a)

This inspection was carried out on 9th May 2006.

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

The inspector found 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 16 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Haddon (32a) 03/01/08

Haddon (32a) 01/11/05

Haddon (32a) 25/07/05

Haddon (32a) 14/02/05

Haddon (32a) 19/07/04

Haddon (32a) 08/12/03

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

CARE HOME ADULTS 18-65 32a Haddon 32a Haddon Great Holm Milton Keynes Bucks MK8 9HP Lead Inspector Barbara Mulligan Unannounced Inspection 9th May 2006 09:30 DS0000048436.V290150.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000048436.V290150.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000048436.V290150.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service 32a Haddon Address 32a Haddon Great Holm Milton Keynes Bucks MK8 9HP 01908 262814 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) www.macintyrecharity.org Macintyre Care Mrs Claire Helen Dove Care Home 14 Category(ies) of Learning disability (14) registration, with number of places DS0000048436.V290150.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st November 2005 Brief Description of the Service: Set on the edge of Great Holm, no.32a Haddon, owned by MacIntyre Care, is located within a campus style complex, in amongst private housing. It provides accommodation to adults with learning disabilities. 32a Haddon is situated within walking distance of the local shops, church and local pubs. The building itself contains five self contained flats and a small garden area. There is a further complex of buildings that comprise of no. 42a and no. 52a Haddon, the organisations day care services, a hall, a nursery and garden centre, a craft shop, a coffee shop, bakery and an administration office. The coffee shop and bakery occupy the corner of the site and this provides occupational opportunities for service users and enables local residents to visit the shop. The nursery, garden centre and craft shop also provide occupational activities for service users and are open to the public.The centre of Milton Keynes is close by offering a large shopping centre, cinema, a range of restaurants and recreational activities, cycle tracks and many other attractions. Service users are encouraged and supported to use public transport to which they have access. Fees range from £22,000 to £39,000 per year. DS0000048436.V290150.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took place on 8th May 2006 at 9.30am on a Tuesday morning. The visit consisted of discussions with service users, support staff and the registered manager, records, policies and procedures were examined and a tour of the premises was undertaken. The inspection officer was Ms. Barbara Mulligan. The registered manager was Claire Dove. Twenty-five of the National Minimum Standards were assessed during this visit. Thirteen of these are fully met and twelve almost met. As a result of the inspection the home has received sixteen requirements. Service users, both those interviewed and those who responded to the survey expressed a high level of satisfaction with the care received from support staff. However, comments received from relatives expressed dissatisfaction that the parents meetings had stopped, with the conditions of the living environment and with staffing levels. The evidence seen and comments received, indicate that this service meets the diverse needs [e.g. religious, racial, cultural, disability] of individuals within the limits of its Statement of Purpose. Numerous requirements have been made at the two previous inspections but the registered provider has failed to comply with these, and the Commission for Social Care Inspection will consider enforcement action if they do not improve following this report. What the service does well: Service users value the relationship and quality of care provided by support staff. The home has maintained the quality standards that surround each admission made into the home. Staff recording practices on daily logs and healthcare intervention sheets is good. Service users are enabled to make decisions about their day to-day activities, evidenced via monthly service users meetings. Individuals are encouraged to lead independent lives and there are varied and numerous opportunities for service users to undertake employment, further education and day care activities. Service users receive good healthcare support via regular routine consultations. DS0000048436.V290150.R01.S.doc Version 5.1 Page 6 Medication is well managed in the home with relevant procedures in place for the administration of medicines. The staff team are motivated, undertaking relevant training and working towards their National Vocational Qualifications. Risk assessments are detailed and thorough. These cover the risks associated with assisting with medication and other health related activities. What has improved since the last inspection? What they could do better: Mandatory training needs to be completed by all staff within six weeks of employment so they are appropriately equipped to deal with service users’ issues and meet their needs appropriately. Training to be completed at induction includes fire training, first aid training, moving and handling training and basic food hygiene training. The registered manager needs to ensure that staff are not preparing meals until they have completed basic food hygiene training. This has been made a requirement of this report. The outcome of complaints needs to be recorded in the complaints log. Of serious concern is the practice of wedging bedroom doors open with various items. The registered provider needs to ensure that a more suitable system is implemented for keeping bedroom doors open and this will be a requirement of this report. DS0000048436.V290150.R01.S.doc Version 5.1 Page 7 There are several on-going issues with the environment that need attention. These include: a) the kitchen in flat 30 is replaced. b) the radiator in the bathroom of flat 30 is covered. c) the carpets in the lounge and hallway of flat 30 are cleaned. d) the kitchen in flat 24 is replaced. e) the lounge carpet in flat 28 is cleaned. f) the carpet in the identified bedroom, in flat 28, is either refitted or replaced and cleaned. g) an assisted bath is installed in flat 28. The unit needs to maintain evidence that support staff have been subject to robust recruitment checks before they commence employment. The registered provider is required to supply to the Commission, copies of certificates for the servicing of the gas appliances. It is recommended that internet access is made available for service users personal use, that a new bathroom is installed in flat 32 and that the registered manager is allocated an appropriate work area in which to complete necessary paperwork, carry out staff supervisions and annual appraisals without interruptions. 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. DS0000048436.V290150.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000048436.V290150.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users needs are thoroughly assessed prior to admission ensuring that staff are prepared for admission and have a clear understanding of the service users requirements. All service users have a written, individual service contract ensuring that there is an understanding of the homes terms and conditions. EVIDENCE: One service user has moved back into 32 A Haddon since the previous inspection. There have been no other admissions to the unit. Each service user has a detailed and comprehensive needs assessment on file which demonstrates that service users have been involved in this process. The assessment tool is called “Moving into Macintyre Care” and is comprehensive and detailed. This is dated June 2003. Pictures are included alongside written information to enable the potential service users to understand the process. All service users have a contract/statements of term and conditions and these cover all areas detailed in Standard 5. The unit does not take emergency admissions nor is intermediate care offered. DS0000048436.V290150.R01.S.doc Version 5.1 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 at least once during a 12 month period. 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. Care planning documentation has improved and adequately provides staff with the information they need to satisfactorily meet service users needs. Support staff enable service users to make decisions in relation to their own lives, providing information, assistance and support to maintain their independence. Service users are supported to take responsible risks within the context of individual risk assessments and risk management strategies that ensure service users can have independent lifestyles. EVIDENCE: A random selection of service user plans were examined during the inspection and it is pleasing to see that files have been reviewed and improved to reflect the changing needs and personal goals for service users. Plans of care demonstrate that all aspects of the health, personal and social care needs of individuals are met. DS0000048436.V290150.R01.S.doc Version 5.1 Page 11 Risk assessments were observed in regard to service users who can or cannot manage their own money, road safety, hot water and travelling independently. Other risk assessments in place cover service users activities and household tasks. Service users have monthly flat meetings and this was confirmed in discussions with service users spoken to during the visit. Minutes are kept and these were looked at. These demonstrate that service users have the opportunity to make decisions about their lives and how choices are made. It is concerning to note that following Regulation 26 visits service users are being told that they must make their beds. Staff informed the inspector that this has caused some difficulties and has upset several individuals. Service users rights to make decisions need to be respected and limited only through the assessment process and then recorded in care plans. Each individual has a bank account and their benefits are paid into their own personal accounts. There is a service users forum that individuals can attend which is held on a fortnightly basis. This is used to discuss any issues the service users feel are important. This is also an opportunity for service users to have an input into the organisations policies and procedures. DS0000048436.V290150.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 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. Service users are able to access a wide range of amenities which meet their social, leisure and spiritual needs. The unit promotes ‘flexible’ visiting and the daily routines of the home promote individual choice, providing service users with the ability to be as independent as their needs allow. Service users are supported to develop their own menus and participate in some cooking tasks, which promotes independence and choice while at the same time reinforcing independent living skills. EVIDENCE: DS0000048436.V290150.R01.S.doc Version 5.1 Page 13 Day services provide opportunities for further education. Examples given to the inspector include training courses on literacy, computer skills, railway and vehicles, sports, filming and science. There is evidence in care plans of placements and activities that service users attend. One service user spoken to said that he attends Computer skills training and “ I can go on the internet”. He likes to send e-mails to family and friends, but is only able to do this on the days he attends the course as there is no internet access in the flat. There is adequate staff support for service users to enable ample opportunities for social inclusion. Most service users go to work and this may be on site, where there is a coffee shop, a bakery and a nursery. Service users take part in varied leisure activities and use local community facilities regularly. Examples given are the local leisure centre, cinema, shops, library, health centre and local pubs and restaurants. Many local residents and members of the public visit the coffee shop where service users are employed, and staff support the service users to become part of, and participate in, the local community. Service users have access to transport and use taxis, buses, dial-a-ride and trains and this is recorded in care plans and confirmed through discussions held with service users. Individuals vote, and do so by proxy or by attending the local polling station on voting day. There are no restrictions about family and friends visiting. This is detailed in the Service Users Guide. Service users spoken to confirmed that their friends and/or their partners visit them and are able to stay. Staff assist service users to make regular phone calls and to write letters to family and friends. Many service users have their own mobile phones. It is pleasing to see that a date has been set for the parents meetings to recommence, thus ensuring the views of family, friends and advocates and of stakeholders in the community are allowed to be aired and taken into account. All service users have keys to the front doors of their flats and each flat has its own doorbell. Service users open their own mail, and this is collected from the staff block where it is delivered. Staff support service users with reading and understanding the content of their mail, if help is required. Preferred terms of address are recorded in service users care plans. Interaction between staff and service users was observed during the inspection and this is done with respect and in a manner that is appropriate to service users. Housekeeping rotas are kept in individual’s flats and some of these are in picture form. These include such tasks as cooking the evening meal, washing up and cleaning. DS0000048436.V290150.R01.S.doc Version 5.1 Page 14 Service users choose their own menus at their flat meetings. Meals are offered three times a day and service users have access to snacks and drinks throughout the day. A record is kept of all meals provided. Service users are weighed regularly and this is recorded in their care plans. Where individuals have decided they don’t want to be weighed monthly there is a risk assessment in place. DS0000048436.V290150.R01.S.doc Version 5.1 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Personal and healthcare support for service users is good and the systems for the administration of medication are generally well managed, protecting service users and ensuring their personal and healthcare needs are appropriately met. EVIDENCE: Information regarding personal care is recorded in the service users plans. Personal support is provided either in bedrooms or bathrooms. One service user spoken to said “ I can lie in bed at the weekend but go to work in the week”. Other service users spoken to during the visit confirmed that individuals choose their own clothes and hairstyles, some with support from their link workers. One service user has increased mobility needs and has been waiting for an assisted bath to be installed. This has been made a requirement under Standard 29. DS0000048436.V290150.R01.S.doc Version 5.1 Page 16 There is evidence on file of the healthcare support available to service users and it is clear that routine appointments are attended in line with NHS entitlements and all initiatives recorded. Each service user has a MacIntyre health care action plan. It is envisaged that the PCT will also supply each service user with a Health Care Plan. This will duplicate all healthcare information available for service users and this may need to be reviewed. Service users are supported and facilitated to manage their own healthcare where practicable. Service users visit their G.P. on a needs only basis. Service users locally access chiropody services. Specialist services such as physiotherapy, occupational therapy and speech therapy can be accessed via a referral through the G.P. or via the Community Team for People with Learning Disabilities. The registered manager said that problems have been experienced trying to access a local NHS dentist. The previous dentist used by service users has become a private practice. She continues to search for a suitable dentist surgery. Staff provide support to service users needing to attend outpatient and other appointments. The unit operates a link worker system. Service users are encouraged to self-administer their own medication and risk assessments are in place for this. The inspector looked at a record of current medication kept for each service user. These are completed accurately and there were no omissions noted. The home uses a monitored dosage system. Unused medication is disposed of via the pharmacy. There are no controlled drugs in use. The registered manager stated that a nearby pharmacist is now carrying out medication training and the inspector observed evidence of this. Overall, the storage and administration of medications was found to be good. A minimum number of medications are held in the home, they are stored in an appropriate facility and all are within their ‘use by’ dates. DS0000048436.V290150.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome is good. This judgement has been made using available evidence including a visit to this service. There are systems in place that enable service users, staff and stakeholders to make comments about the quality of the service in a non-judgemental manner. Staff have a good knowledge and understanding of Adult Protection issues which protect service users from abuse. However, training records examined demonstrate that several staff have not received POVA training which could put service users at risk. EVIDENCE: DS0000048436.V290150.R01.S.doc Version 5.1 Page 18 There is a complaints procedure dated March 2003. This is in pictorial/photo form in the staff office and in individual flats. A summary of the complaints procedure is included in the Statement of Purpose and Service Users Guide. This includes information on how to refer a complaint to the Commission. The unit has a dedicated book for the recording of complaints. The unit has received two complaints since January 2006. The first complaint was from a relative who was unhappy about the temperature of the water from the shower in flat 32. The inspector checked previous recorded temperatures for this shower. Records show that the shower has been running at a temperature between 61ºc and 63ºc. The registered manager said that she has had the shower checked by the maintenance department. The inspector checked the temperature of the shower on the day of the visit and this was recorded at 43ºc. However, the complaints log does not record the outcome of this complaint. The second complaint was again from a relative who was unhappy about their relative walking to the local shop without an escort. The registered manager said that this service user no longer leaves the unit without an escort. Again the complaints log does not record the outcome of this complaint and this will be requirement of the report. All complaints are reviewed monthly and these are sent to the organisations central office. The unit use the Milton Keynes “Protecting Vulnerable Adults from Abuse” policy and a MacIntyre Care policy called “Protecting Vulnerable Adults from Abuse” dated September 2003 There are guidelines for staff about the responsibilities of the staff, types and signs of abuse and what to do if you suspect abuse. There is a public disclosure policy dated Sept 2003. Staff spoken to are aware of how to report any suspected abuse and were also aware of when it would be necessary to disclose information given to them in confidence. During discussions with care staff, and following examination of training records it was evident that not all staff have received POVA training. This was a requirement of the previous report and will remain a requirement of this report. There is a Whistle Blowing policy and a Physical Intervention Policy dated September 2002. The organisations policies regarding service users money and financial affairs ensure service users access to their money, valuables and safe storage is safe guarded. There is a gifts procedure that provides staff with guidelines about receiving personal gifts from service users. DS0000048436.V290150.R01.S.doc Version 5.1 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27, 29 and 30. Quality in this outcome is adequate. This judgement has been made using available evidence including a visit to this service. The standard of the environment within the flats is adequate, providing service users with an attractive and homely place to live. However, prompt attention to repairs and maintenance of the flats needs to be sustained, to ensure they remain safe, comfortable and accessible to the people living there. The overall quality of the furnishings and fittings is good ensuring the safety and comfort of service users. Standards of cleanliness in the flats has improved, meaning that service users live in an environment that is clean and hygienic, protecting their health, safety and welfare. EVIDENCE: DS0000048436.V290150.R01.S.doc Version 5.1 Page 20 32a Haddon consists of 5 flats. Each flat was visited during the inspection. Flat 28 is nicely decorated, homely, bright and cheerful. During the previous unannounced inspection there had been a burst pipe and consequently a leak in one of the service users bedrooms. There was a strong smell of damp and the service user had to sleep on the sofa in the lounge. It is pleasing to see that this problem has now been resolved. At the previous inspection the bathroom was due to be replaced with an assisted bath, due to the reduced mobility needs of one service user. However at the time of this visit work still had not commenced. This has now become an urgent issue and will be a requirement of this report. The kitchen has been replaced and service users at home proudly showed the inspector their new kitchen. One service user said “its better than the old one, the old one kept conking out”. The carpet in one bedroom has started to gather up in places and will soon become a trip hazard. This carpet is also grubby and either needs to be refitted and cleaned or replaced. The lounge in this flat is nicely decorated but the carpet is extremely grubby and requires cleaning. One service user living in this flat attends IT training and has his own laptop. He would like to have Internet access for his hobby and this is a recommendation of the report. Flat 30 is nicely decorated, homely, bright and cheerful. The carpets in the lounge and the hallway are grubby and require a clean. Climbing equipment for one service user is stored in the lounge and this is inappropriate. However, the registered manager stated that she is in the process of having a shed erected in the garden to provide more storage space. A requirement was issued following the previous inspection that suitable storage facilities are provided for the use of service users. It is pleasing to see that the registered manager has obtained quotes to have cupboards built in each flat. A previous requirement for the radiator in the bathroom to be covered has not been met and will be a requirement of this report. It was a requirement of the previous announced inspection and unannounced inspection, for the kitchen to be replaced. The cupboard door next to the oven is burnt and is proving to be hazardous in its present position. This will remain a requirement of this report. Flat 32 is pleasantly decorated and is bright and spacious. It is pleasing to see that the problems of mildew and damp identified at the previous two inspections appear to have been resolved. The bathroom in this flat is in a poor state of decorative repair and one service user spoken to said that he would like the bathroom to be painted. Service users would benefit from a new bathroom. It is pleasing to see that a new kitchen, worktops and flooring have been installed. DS0000048436.V290150.R01.S.doc Version 5.1 Page 21 Flat 24 is a one bedroom flat. The lounge is nicely decorated. A requirement was made following the previous inspection that the bath and toilet are replaced due to damage. The bath has now been replaced with a shower and there is new flooring. Several kitchen cupboards are damaged and the worktops are worn and need to be replaced. This has been a requirement of the previous two inspections and will be a requirement of this report. Flat 26: Service users were out at their places of work during the visit and so the inspector did not enter this flat. During a tour of the premises it was evident that the general cleanliness of each flat has greatly improved. However, during discussions held with staff concerns were raised about the time support staff spend cleaning flats. This is usually carried out during the day, often when service users are at their place of work. Staff feel that service users are loosing necessary skills because staff are having to complete the cleaning of flats while they are at work. Staff also felt that when service user are at home, time is not being spent appropriately supporting service users, but is spent cleaning. Serious consideration needs to be given to providing extra staff or extra staff hours to support service users with the cleaning of their flats. This is a recommendation of the report. It is pleasing to see all the environmental changes that have been made to the individual flats have enhanced the living environment for service users and improved access. The unit has a planned maintenance and renewal programme for the fabric and decoration of the premises. There were no CCTV cameras in use at the time of the inspection. DS0000048436.V290150.R01.S.doc Version 5.1 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35. Quality in this outcome is adequate. This judgement has been made using available evidence including a visit to this service. There are effective recruitment procedures in place to ensure service users are protected from harm. However, there is no evidence available in the unit to demonstrate that all recruitments checks have been undertaken. While the range of staff training and development offered via MacIntyre Care is good, access to this training is difficult which results in necessary training not always being up to date and does not ensure staff are appropriately equipped to deal with service users’ issues or able to manage their care effectively. EVIDENCE: Progress is being made with NVQ training. At the time of the visit there was 1 staff member with NVQ level 2, a relief staff with level 3, the registered manager is undertaking NVQ level 4 and the deputy manager is in the process of completing NVQ level 3. Another two support staff have just commenced NVQ level 3 training and level 2 training. There are four trainees completing CWPLD training. A request was made to look at files for the most recently employed support staff. The registered manager was informed that documentation for these individuals are kept at a central office and this is to be the practice of the DS0000048436.V290150.R01.S.doc Version 5.1 Page 23 organisation. The unit needs to maintain evidence that all necessary recruitment checks have been undertaken and this is a requirement of the report. New staff undertake a one day corporate induction. They are then expected to complete a personal development portfolio, undertake CWPLD training and complete all mandatory training. During a group discussion with staff they said that this was extremely difficult to complete within the six months probationary period. One staff member told the inspector that she has been in post for almost a year and has not managed to complete this training yet and therefore unable to complete her probationary period. However, there remains an unacceptable delay between staff commencing employment and staff completing the necessary mandatory training. Unless care staff receive the necessary training at their initial induction they will not be appropriately equipped to deal with service users’ issues or meet their needs appropriately. This was a requirement of the previous report and it is a requirement of this report that staff receive the necessary training at induction, before they are required to carry out tasks for which they are not trained. DS0000048436.V290150.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome is adequate. This judgement has been made using available evidence including a visit to this service. The registered manager is qualified, competent and experienced to run the home and meet its stated purpose, aims and objectives. The home has implemented a quality assurance system but this needs to be strengthened and delivered more consistently to ensure the home is being proactive in identifying issues that may effect the well being of services users. Overall health and safety procedures are not being adequately maintained. Mandatory training needs to be updated for several staff and serious consideration needs to be given to alternative ways to keep bedroom doors open without using door wedges, ensuring the safety of service users. EVIDENCE: DS0000048436.V290150.R01.S.doc Version 5.1 Page 25 The registered manager has been employed by Macintyre Care since 1993, and has been in post as head of service for approx seven years. She is presently undertaking her NVQ level 4 training. Further training includes medication awareness, supervision training, managing staff sickness and mandatory training. The registered manager needs to ensure that she remains supernumary at least three days a week to allow for time to complete all managerial tasks. The staff office is very small and busy. The registered manager said she has requested permission to use another office, on site, periodically, to allow her to complete necessary paperwork and carry out staff supervisions and annual appraisals without interruptions. This will be a recommendation of the report. The registered manager has the overall responsibility for ensuring the homes written aims and objectives are achieved, the homes budget is properly managed, policies and procedures are implemented, and certificates are displayed and that the home complies with the Care Standards Regulations. Internal audits include staff sickness, service users monies, staff training, accidents/incidents, service users support plans, NVQ monitoring forms are used, risk assessments and agency monitoring. The unit has recently sent out a service satisfaction questionnaire and these are evident in service user files. Information from these questionnaires has been sent to the service manager and the inspector requests that a copy of the published results is sent to the Commission. Feedback is also obtained from service users through flat meetings and link worker meetings. Minutes of these meetings are maintained and observed. Regulation 26 visits are being undertaken monthly and the Commission receives copies of these. A questionnaire has recently been sent to relatives and there is a parents meeting due to be held on 20th May 2006. Several comments received by the Commission, via comments cards, indicate that relatives and service user representatives are concerned that the relatives meetings have ceased. It is pleasing to see that they are now due to recommence. Fire Safety Records were looked at. The unit’s fire risk assessment has been reviewed and updated as necessary. Records seen of weekly fire alarm testing, emergency lighting checks, regular servicing reports of fire equipment are up to date and accurate. There is a record of monthly fire evacuations and these are carried out with service users. During a tour of the flats the registered manager informed the inspector that several service users were still propping several doors open with various articles and this was an on going problem. It is a requirement of the report that a more suitable system is implemented for keeping bedroom doors open to prevent the use of door wedges. Fire training records observed demonstrates that not all staff are up to date with mandatory fire training. During a group discussion with staff, one relief staff member stated that she commenced employment in August 2005 and has not yet received Fire Training. She is usually based at a supported living DS0000048436.V290150.R01.S.doc Version 5.1 Page 26 scheme and not at 32 A Haddon. It was a requirement of the previous two inspection reports that all staff receive up to date fire training and will remain a requirement of this report. Training records demonstrate that Moving and Handling training and first aid training needs to be updated for several staff. One staff member spoken to during the visit said that she commenced employment in June 2005 and has not yet received Moving and Handling Training. This is a requirement of the report. It is evident through staff discussions, that food preparation is being undertaken by support staff who have not yet completed basic food hygiene training. It is a requirement of this report that support staff do not prepare food or assist in meal preparation until they have completed basic food hygiene training. The unit has no service certificates for gas appliances. The registered manager said that this was completed on 24th November 2005 but the unit has not received the certificates. The inspector requests that copies of these are sent to the Commission and is a requirement of the report. Hot water is not thermostatically controlled, but hot water outlets are risk assessed and tested weekly. PAT testing is carried out annually and this was last carried out on 17th September 2005. Window restrictors are in place and these are risk assessed. A monthly check of the environment is carried out and security checks of the premises are undertaken nightly. A Health & Safety manual is available for staff. This is detailed and informative and attempts have been made to ensure this file is user friendly and contained a picture guide. Records were seen of accidents and incidents and these are monitored on a monthly basis. There are data sheets and COSHH risk assessments in place. Insurance certificates are displayed in the unit. The staff office and sleep in area are small and lack storage space. Staff spoken to said that they found it difficult to find a suitable space to undertake paperwork and staff supervision. At the previous unannounced inspection difficulties were being experienced with records that needed archiving. There was no room to do this within the unit and it was recommended that the registered provider give serious consideration to suitable storage facilities for the storage of old/archived records. This has now been resolved and archiving is being completed twice a year. DS0000048436.V290150.R01.S.doc Version 5.1 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 3 28 X 29 2 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 2 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 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 3 X X 2 x DS0000048436.V290150.R01.S.doc Version 5.1 Page 28 yes 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 The registered provider is required to ensure that all support staff receive POVA training. (Previous timescale of 30/03/2006 not met) The registered manager is required to ensure that the outcomes of complaints are recorded in the complaints log. The registered provider is required to ensure that the kitchen in flat 30 is replaced. The registered provider is required to ensure that the radiator in the bathroom of flat 30 is covered. (Previous timescales of 30/05/05 and 30/01/2006 not met.) The registered manager is required to ensure that the carpets in the lounge and hallway of flat 30 are cleaned. The registered provider is required to ensure that the kitchen in flat 24 is replaced. (Previous timescale of 30/08/2005 not met) The registered manager is required to ensure that the lounge carpet in flat 28 is DS0000048436.V290150.R01.S.doc Timescale for action 30/08/06 2 YA22 22 30/05/06 3 4 YA24 YA24 23 23 30/06/06 30/06/06 5 YA24 23 30/06/06 6 YA24 23 30/07/06 7 YA24 23 30/06/06 Version 5.1 Page 29 cleaned. 8 YA24 23 The registered manager is required to ensure that the carpet in the identified bedroom, in flat 28, is either refitted or replaced and cleaned. The registered provider is required to ensure that an assisted bath is installed in flat 28. The registered provider is required to ensure that the unit maintain evidence of all recruitment checks for staff, as detailed in Schedule 2. The registered provider is required to supply copies of gas servicing appliances to the Commission. The registered provider is required to ensure that a more suitable system is implemented for keeping bedroom doors open to prevent the use of door wedges. The registered provider is required to ensure that all support staff receive first aid within the first six weeks of employment. The registered provider is required to ensure that staff receive basic food hygiene training within six weeks of employment, and until staff complete this they do not prepare or help to prepare meals. The registered provider is required to ensure that all staff receive Moving and Handling training within six weeks of employment and this is updated as necessary. The registered provider is required to ensure that all staff receive Fire Training within six DS0000048436.V290150.R01.S.doc 30/06/06 9 YA29 23 30/09/06 10 YA34 17 Schedule 4 30/05/06 11 YA42 23 30/06/06 12 YA24 23 30/05/06 13 YA42 18 30/07/06 14 YA42 18 30/07/06 15 YA42 18 30/07/06 16 YA42 18 30/06/06 Version 5.1 Page 30 weeks of employment. 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 3 Refer to Standard YA29 YA27 YA28 Good Practice Recommendations It is recommended that Internet access is available for service users. It is recommended that a new bathroom is installed in flat 32. It is recommended that the registered manager is allocated an appropriate work area in which to complete necessary paperwork and carry out staff supervisions and annual appraisals without interruptions. DS0000048436.V290150.R01.S.doc Version 5.1 Page 31 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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