Inspection on 24/06/08 for Heads Meadow

This inspection was carried out on 24th June 2008.

CSCI found this care home to be providing an Adequate service.

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 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Heads Meadow 29/07/09

Heads Meadow 27/06/07

Heads Meadow 28/09/06

Heads Meadow 01/03/06

Heads Meadow 20/09/05

Heads Meadow 15/10/04

Heads Meadow 23/03/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOME ADULTS 18-65 Heads Meadow 41 Ball Road Pewsey Wiltshire SN9 5NB Lead Inspector Elaine Barber Unannounced Inspection 24th June 2008 10:15 Heads Meadow DS0000028201.V361597.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 Heads Meadow DS0000028201.V361597.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. Heads Meadow DS0000028201.V361597.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Heads Meadow Address 41 Ball Road Pewsey Wiltshire SN9 5NB 01672 563851 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) Steven@StevenAbbott.wanadoo.co.uk Mrs Jane Abbott Mrs Jane Abbott Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Heads Meadow DS0000028201.V361597.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th June 2007 Brief Description of the Service: Heads Meadow is run by Valued Lives, a private organisation, which operates 5 care homes for adults with learning disabilities. All are small establishments, intended to offer a normal domestic lifestyle. The main lead for the organisation is taken by the registered person, Mrs Jane Abbott. She is supported by other senior colleagues, including family members. Each of the Valued Lives homes is situated in Pewsey, or nearby small villages. Pewsey itself offers a range of amenities. The market towns of Marlborough and Devizes are within 15 minutes’ drive. The organisation has a number of vehicles used to take people out and people contribute towards the costs of these. Most people have lived in houses owned by the organisation for several years. They may have lived in more than one of the homes run by Valued Lives. Up to five people live at Heads Meadow in Ball Road, Pewsey. All have single rooms. There is one ground floor bedroom. People have a choice of bath or shower. Plenty of communal space is available including a large kitchen dining area and three sitting rooms. There is also a large garden. The fees range from £677 to £1100 per week. Heads Meadow DS0000028201.V361597.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. We received an Annual Quality Assurance Assessment (known as the AQAA) from the home. This was their own assessment of how they are performing. It also gave us information about what has happened during the last year. However, it focused on developments in the organisation and did not tell us much about outcomes for people who live at Heads Meadow. We sent surveys to the people who live at Heads Meadow, so that we could get their own views about the home. We did not receive any back. We looked at the AQAA and reviewed all the other information that we have received about the home since the last inspection. This helped us to decide what we should focus on during a visit to the home. We made a visit to the home on 24th June 2008. We spoke to the residents, and to four staff members, including two seniors. We also spoke to the home’s manager, Jane Abbott on the telephone. We looked at some of the home’s records and went around the accommodation. The judgements contained in this report have been made from all the evidence gathered during the inspection, including the visit. What the service does well: People had lived in the home a long time and staff had got to know their needs well. People also had their needs and aspirations assessed so that they could be met by the home. Each person had an individual contract and statement of terms and conditions with the home to ensure that their interests were safeguarded. Some people had their abilities, needs and goals reflected in up to date individual plans so that their needs and aspirations could continue to be met. People were supported to make choices and made decisions about their lives with assistance as needed. Risks were assessed and action to be taken to reduce risks was recorded. People were given opportunities and supported to take risks. People were provided with a range of activities and opportunities, offering access to their local community. They had a variety of daytime activities arranged by the organisation. They attended a social club. At home people enjoyed knitting, listening to music and watching television. People were able to maintain and develop appropriate relationships with family and friends. Heads Meadow DS0000028201.V361597.R01.S.doc Version 5.2 Page 6 People’s rights were respected and their responsibilities were recognised in their daily lives. People enjoyed their meals. People received support in ways they preferred and required. Each person was registered with a GP and saw other professionals as needed including the psychiatrist, psychologist, community nurse and chiropodist. Their physical and emotional health needs were met and they were generally protected by the home’s policies and practices about medication. There were policies and procedures about complaints and protection. People had been given information about how to make a complaint. Staff had received training about prevention of abuse. People were generally protected by the home’s policies and practices about complaints and protection. People lived in a comfortable, clean and safe environment, suitable to their needs. The home was kept clean and there was a separate laundry room. The accommodation was comfortably furnished and decorated. People were supported by an effective staff team, who were appropriately trained, competent and qualified to meet their needs. More than half of the staff had a National Vocational Qualification at level 2 or above. Staff had a range of training to meet a variety of needs. The registered manager was suitably experienced to run the home. There were risk assessments and health and safety checks. The temperature of the water was regulated and radiators were covered to reduce the risk of scalding and burns. People’s health and safety were protected by the systems in place. What has improved since the last inspection? What they could do better: The system of care planning should be simplified to make the plans easy for staff to use as working documents and to ensure people’s needs are met. New care plans should be developed for each person to ensure they are up to date and their needs continue to be met. New risk assessments should be developed for each person to ensure that they are up date and people are kept safe from unnecessary risks. A new medication cupboard should be provided that complies with the new storage requirements for controlled drugs so that the home is prepared if a person is prescribed a controlled drug. Heads Meadow DS0000028201.V361597.R01.S.doc Version 5.2 Page 7 Some people may be at risk of harm because their plans to manage their behaviour still need to be agreed with professionals involved. People were not protected by the home’s recruitment practices. Two written references must be received before a new member of staff starts work. When a member of staff is employed following a POVA first check, and before their CRB check, a risk assessment should be conducted to ensure that people are protected from being cared for by unsuitable staff. New staff should receive Learning Disability Award training as underpinning knowledge for NVQ’s. All staff should receive equality and diversity training so they know how to recognise and meet people’s diverse needs. The home was not providing evidence that they took responsibility for their own quality assurance and that people’s views underpinned all self-monitoring, review and development by the home. People’s views need to be collected again and a report produced of the findings to identify improvements for people who live in the home. The stair carpet must be repaired or replaced so that people are safe when using the stairs. The thermostatic valves on taps should be serviced regularly to ensure that they continue to regulate the water temperature and people are protected from being scalded. 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. Heads Meadow DS0000028201.V361597.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 Heads Meadow DS0000028201.V361597.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 4 Quality in this outcome area is good. People had their needs and aspirations assessed so that they could be met by the home. Each person had an individual contract and statement of terms and conditions with the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There had been no admissions to the home since the previous inspection, in 2007. People’s needs had been assessed over time. We read the records of three people. Each of these had assessment information in their files. One of them had a community care assessment. They all had contracts with the local authority that paid their fees and with Valued Lives. Heads Meadow DS0000028201.V361597.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is adequate. Some people had their abilities, needs and goals reflected in up to date individual plans so that their needs and aspirations could continue to be met. People made decisions about their lives with assistance as needed. People were given opportunities and supported to take risks. However assessment of risks needs to be kept up to date so that people are kept safe. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each person had an old style care plan, which provided detailed information about how their care needs would be met. However, these plans were very long and sometimes it was difficult to find information. New style care plans had been introduced which were clearer and easier to follow. Two of the people had new care plans. A new plan had been started for the third but this Heads Meadow DS0000028201.V361597.R01.S.doc Version 5.2 Page 11 needed to be completed. The two people who had new care plans also had additional guidelines for each aspect of care. These guidelines needed to be developed for the third person. A person centred plan had been started for two people but not finished. Health action plans had also been started for these two people. There was evidence that two people’s plans had been reviewed in March 2008. There were daily and weekly review sheets, which recorded progress with daily activities. We noted at the last inspection that two people had a new style care plan and a third person needed to have a new care plan developed. We did not see any progress with developing care plans for everybody. Information was difficult to find in the files and it was hard to tell which was the most up to date information. The old style care plans were not dated. The new style care plans were dated but the additional support guidelines were not. The system for care planning was complicated. The records showed that people were encouraged to make choices. They showed that people had chosen activities for their day service. Staff gave examples of people choosing their menus using recipe cards. People were observed choosing where to spend their time when they returned from their day time activities. Some people were in the sitting areas while others were in their rooms. People’s rooms were individually decorated and furnished according to their choice. The care plans and risk assessments placed a high emphasis on choice and independence. Two people had a range of detailed risk assessments. These included the action to be taken to reduce risks. They also focused on promoting independence, choice and opportunities for people. The third person had old style risk assessments, which included actions to reduce risks. New risk assessments needed to be developed for the third person. We noted at the last inspection that new risk assessments had been developed for two people and a third needed new risk assessments. We did not see any progress with developing the risk assessments. Heads Meadow DS0000028201.V361597.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 Quality in this outcome area is generally good. People were provided with a range of activities and opportunities, offering access to their local community. People were able to maintain and develop appropriate relationships with family and friends. People’s rights were respected and their responsibilities were recognised in their daily lives. People enjoyed their meals. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at the records of three people. We noted that these people had a range of activities. Each person had an individual timetable of activities at the activity centre run by Valued Lives. Some people went to the Gateway club on a Thursday evening. People who were spoken to on their return from the day service said that they enjoyed their day time activities. The records showed that each person had had a holiday this year in the caravan owned by the Heads Meadow DS0000028201.V361597.R01.S.doc Version 5.2 Page 13 organisation. They also said that people had had a range of outings during the summer. People’s individual needs and preferences were taken into account when choosing outings and activities. The daily records showed that people had a wide variety of activities at their day service. These included craft, bingo and music. People also used community facilities such as the café, shops and the cinema. The records showed that some people went to church and had been confirmed last year. People said that they saw visitors from the church at their day service on the day of our visit. The records showed that at home activities included knitting, reading, writing, listening to music and watching TV. A member of staff said that people were involved in the routines of the home according to their abilities. They said that people were encouraged to be involved in laying the table, drying the dishes, shopping, vacuuming, preparing vegetables and sorting laundry. Staff respected people’s privacy and knocked on doors before entering their rooms. People chose whether to be alone in their rooms or in company. We saw that people chose to sit in one of the lounges or go to their rooms after they came back from their day service. People could have pets and in the house there were a cat and a parrot. One person said that they fed the cat. The manager told us in the AQAA that a new small holding had been bought. The two senior members of staff told us that a small farm was being developed to give people more opportunities for day time activities. Animals including donkeys, goats, alpacas and a horse had been bought. Polytunnels had been put up to grow plants. They said that people were not yet going on a regular basis for activities but they had visited. One person told us that they had visited and they liked the donkeys. Staff reported and the records showed that people kept in contact with their families. Relatives and friends visited them at home. People also had friends from the other Valued Lives houses. People could meet other people who did not have similar needs when they accessed community facilities. The local vicar provided a special service for people from Valued Lives. The senior staff member reported that other people from the community were starting to join in with this. When we asked to see the menu it could not be found. A member of staff said that a large amount of fruit and vegetables was offered. Advice had been sought from a dietician about the menu. We saw that there was a section about nutrition in the care plans. The senior staff member said that people were offered choices within a nutritional framework. They also said that people chose dishes for the menu from picture menu cards. People helped with cooking and setting the table or clearing away after meals according to their ability. One person who was spoken to said that they enjoyed the food. Heads Meadow DS0000028201.V361597.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is good. People received support in ways they preferred and required. Their physical and emotional health needs were met and they were generally protected by the home’s policies and practices about medication. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staff told us that they assisted people with various levels of personal care and provided supervision when needed. This varied depending on their individual abilities. When we looked at the records we saw that people had established routines, such as their preferred time for getting up. These routines were recorded in their personal notes. Staff support was available if people needed assistance to attend set appointments. Assistance was also given to choose clothes on a daily basis. Staff organised shopping trips with people. Each person had an allocated keyworker. One responsibility of this role was to ensure that people had sufficient clothes and toiletries. Heads Meadow DS0000028201.V361597.R01.S.doc Version 5.2 Page 15 We saw that Valued Lives had a policy about staff of the opposite gender providing personal care. This provided suitable safeguards both for people who lived in the home and for staff. When we read the records we noticed that there was a strong focus on health promotion, and also responding to any needs that arose. Each person was registered with a GP. Everyone received regular health monitoring. This included dental and vision check ups. Any specialised services, such as speech therapy or occupational therapy, were also accessed as required. When significant health problems occurred all possible steps were taken to secure treatment for these. Information about the main needs of individual people was available for staff. All appointments took place in private, although a staff member would give assistance as needed. Records were kept of all contacts with any health professional. We saw that people had appointments with the GP, psychiatrist, psychologist, community nurse and chiropodist. Medication was stored in a locked cupboard. However, it was in a position where the medication could be affected by heat and steam. We made a recommendation at the last inspection that the internal temperature of the cupboard should be monitored because there is a risk that some medicines can be affected by changes in temperature. One of the senior members of staff told us that the manager had thought about this but decided that this was not necessary because they had never had any problems and the medication was renewed every two weeks. There were no controlled drugs. The current medication cupboard does not comply with the new requirements for the storage of controlled drugs. Advice about the safe management of controlled drugs in care homes is available on the CSCI professional website. Each person had an individual named box to store all their medication. Staff had received training in medication handling, and in some more specialised techniques. Changes to medication were documented and signed. Each person had a list of homely remedies, which they could take, approved by the GP. Records and letters from a consultant showed that medication was regularly reviewed. There was a medication stock control system and records were kept of medication received into the home, administered, and returned. Heads Meadow DS0000028201.V361597.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is adequate. People were generally protected by the home’s policies and practices about complaints and protection. Some people may still be at risk of harm because their plans to manage their behaviour were not agreed with professionals involved. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was information available about how to make a complaint. A pictorial version of the complaints procedure was available within the Service User Guide. The senior member of staff said that each person had been given a copy. Contact details for the CSCI were included. The Annual Quality Assurance Assessment completed by the owner showed that there had been no changes to the information about complaints. There had been no complaints since the last inspection. Heads Meadow DS0000028201.V361597.R01.S.doc Version 5.2 Page 17 There was also a wide range of information about adult protection issues. This included details about multi-agency procedures within Wiltshire and a policy about preventing abuse. A ‘Protection’ section in each individual’s care plan gave information about the various safeguards in place. These included recruitment checks, staff training, and key individual abilities and relationships that contribute to upholding someone’s welfare. Since the last inspection there had been no vulnerable adult referrals from the home. The senior member of staff said that staff had received training about prevention of abuse from an external training provider. There was a requirement at the last inspection and the one before about strategies for management of behavioural needs. These must contain appropriate guidance, show who has been involved in devising them, and be kept under regular review. Progress had been made towards meeting this requirement at the last inspection. A detailed behaviour management policy and guidelines had been developed for some people. Staff were waiting for the community nurse to agree these. There had been no change to this since the last inspection. The senior member of staff said that they were still waiting for them to be agreed by the community nurse. Staff managed money on behalf of people. Appropriate financial records were kept with receipts. Heads Meadow DS0000028201.V361597.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Quality in this outcome area is good. People lived in a comfortable, clean and safe environment, suitable to their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Heads Meadow was a detached house, set in its own grounds in a residential area of Pewsey. Local amenities were within walking distance. The home was next door to a pub. The property was domestic in style. Décor was homely, using strong colours. It was furnished to a good standard, and appeared well maintained. Any minor issues that arose were attended to as quickly as possible. Redecoration of particular rooms took place as needed. Heads Meadow DS0000028201.V361597.R01.S.doc Version 5.2 Page 19 There was a separate utility room for the laundry. Since the last inspection a cleaning company had cleaned the accommodation twice a week. The home was cleaned to a high standard. The property was not owned by Valued Lives, and they had been required to vacate it by the end of September 2006. The timescale had been extended indefinitely so the provider was considering improvements for the accommodation. Since the last inspection the hall, stairs and landing had been repainted in lighter colours. Heads Meadow DS0000028201.V361597.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 Quality in this outcome area is generally good. People were supported by an effective staff team, who were appropriately trained, competent and qualified to meet their needs. However, they were not wholly protected by the home’s recruitment practices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Heads Meadow had five regular staff who covered most of the shifts at the home. There was a minimum of two staff on duty during daytime hours and one person sleeping in at night. There was an out of hours on-call system. On the day of the inspection the rota showed that there were two staff on duty. These two staff accompanied the people who lived in the home to the day service and supported them there. There were other staff at the day service to assist with activities. There were policies about recruitment and selection practices. All the staff employed had had all the required recruitment checks. This had been confirmed at previous inspections. The manager told us in the AQAA that they Heads Meadow DS0000028201.V361597.R01.S.doc Version 5.2 Page 21 had introduced a four hour work session for prospective staff before they are offered a post. There was one new member of staff. We looked at their recruitment records. They had completed an application form, which included a declaration that they had no convictions. They had also made a declaration that they were physically and mentally fit. A copy of their birth certificate and passport had been kept as proof of identity. Their contract showed that they started work on 19th November 2007. One written reference was received on 15th November 2007 and a Protection of Vulnerable Adults (POVA) first check was made on 16th November 2007. There was no second reference as is required before a member of staff can start work. There was no risk assessment in relation to starting work before a Criminal Records Bureau (CRB) check was received. This check was received on 23rd November 2007. We made a recommendation at previous inspections that when new staff are recruited a reference should be obtained from the previous employer. If they have left school or college a reference should be obtained from the school or college. This was the first member of staff recruited since the recommendation was made. A reference had been received from their previous employer but there was no second reference. At previous inspections we noted that new staff had an initial short induction followed by a three month probationary period. During this time they worked under supervision. Sleep-ins were done with a colleague at first, until the staff member was judged competent to work alone. This new member of staff had an induction and training booklet which showed that they had received training about managing challenging behaviour, ‘No Secrets’, abuse of adults with learning disabilities, effective communication, emergency first aid, food hygiene, customer care and epilepsy management. The member of staff said that this had been training from videos. They also said that they had started their National Vocational Qualification (NVQ) at level 2. Four members of staff had a National Vocational Qualification at Level 2 or above. One was working towards NVQ level 2. The home therefore had above 50 of staff with an NVQ level 2 or equivalent. We looked at the training records. We noted that staff had core training including health and safety, food hygiene, first aid, medication, including special methods of administration, and abuse awareness. There were also courses about epilepsy, challenging behaviour, person centred planning, physical intervention, autism, and dementia in people with Down’s Syndrome. The senior member of staff told us that all staff had had food hygiene refresher training recently and they were waiting for the certificates. There was no evidence that staff received Learning Disability Award training or training about equality and diversity. Heads Meadow DS0000028201.V361597.R01.S.doc Version 5.2 Page 22 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, 42 Quality in this outcome area is adequate. The registered manager was suitably experienced to run the home. The home was not providing evidence that they took responsibility for their own quality assurance and that people’s views underpinned all self-monitoring, review and development by the home. People’s health and safety were protected by the systems in place. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered person for the organisation was Mrs Jane Abbott. She was also the registered manager for Heads Meadow. She had lengthy experience of working with people with learning disabilities and had owned and operated her own services for many years. She had a learning disability nursing qualification. However, she did not have an appropriate management Heads Meadow DS0000028201.V361597.R01.S.doc Version 5.2 Page 23 qualification and was working towards NVQ Level four in management. She was supported by other senior staff within the organisation. Together, they oversaw all five services run by Valued Lives. The other registered managers within the organisation provided support to the various homes if needed. One of the other registered managers, who was one of the senior staff present throughout the inspection, had a City and Guilds qualification in health and social care. She was also working towards NVQ Level 4 in management. The manager completed the AQAA which told us general information about the service as a whole and the business plans. It did not give specific information about outcomes for people who live in the home. They told us that they had improved in the last 12 months by updating the individuals’ personal records and organisational records into a more user friendly format. We found that some people had their records in a more user friendly format but other people’s records had not been updated. They also told us that they had developed a second lifelong learning environment. This was the small holding, which introduced opportunities for further friendship making and wider community involvement. We found that this was still being developed and people in the home had visited to see the animals but were not yet using it on a regular basis. For the last three inspections the registered manager had been working on their quality assurance for the service. The quality assurance framework was based on the systems in the house including policies and procedures, care plans, records and staffing. A consultant had provided advice and guidance about quality assurance. Since the last inspection the manager had developed a quality assurance folder for 2008. This showed that all the processes in the home for example, policies, procedures, care plans, reviews and job descriptions contributed to the quality of the service. Part of this was a quality assurance strategic plan but this had not yet been developed. The views of people who used the service, relatives and visiting professionals had been collected in 2006 and 2007. They showed satisfaction with the service. There were notes of a quality assurance review from 2006 to 2007 but these had not been written up into a plan. The focus in these notes was on staff training and development and use of the buildings rather than outcomes for people who lived in the home. There were no up to date questionnaires or a plan for 2008. There had been developments such as redecoration and the introduction of a small holding but these had not been reflected in an up to date plan. A requirement was made at the last three inspections a copy of the quality assurance report needed to be finalised, sent to the Commission and made available to all people who used the service. This had still not been addressed. Heads Meadow DS0000028201.V361597.R01.S.doc Version 5.2 Page 24 One staff member in the organisation had lead responsibility for health and safety issues. There were monthly health and safety checks. Checks were also made by relevant contractors e.g. servicing of the boiler and portable appliance (PAT) testing. We were told by the senior staff that (PAT) testing was booked for 30th June 2008 and the checks of electrical wiring had been done and were not due again. Potentially hazardous substances were stored securely. There was also product information relating to these. Radiators were covered and there were thermostatic valves on taps to reduce the risk of scalding. A senior member of staff told us that these were not serviced. We looked at the records of fire safety checks and fire instruction. These were well recorded and up to date. Locking of exterior doors has been agreed with the fire safety officer. There were risk assessments in place for people who lived in the home about possible hazard areas, such as use of the stairs, or accessing the kitchen. We noted that the stair carpet was becoming worn on the edges of the treads. One part was likely to become a trip hazard. Heads Meadow DS0000028201.V361597.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 2 X 2 X X 2 X Heads Meadow DS0000028201.V361597.R01.S.doc Version 5.2 Page 26 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 YA17 Regulation 17 (2) (3) (b) Schedule 4 (13) 13-&7 15-1a 17-1a Sch3-3q Requirement Records of food served must be available for inspection at all times. Strategies for management of behavioural needs must contain appropriate guidance, be shared with professionals involved, show who has been involved in devising them, and be kept under regular review. When a new employee starts work before their Criminal Records Bureau (CRB) check has been received and after a Protection of Vulnerable (POVA) Adults first check all other checks, including two written references must have been received. The registered manager must obtain an appropriate management qualification. The registered person must produce a report about the quality assurance survey, supply a copy of the report to the Commission and make a copy of the report available to service DS0000028201.V361597.R01.S.doc Timescale for action 24/06/08 2. YA23 30/09/08 3. YA34 19 24/06/08 4. 5. YA37 YA39 9 (2) b (i) 24 24/12/08 30/10/08 Heads Meadow Version 5.2 Page 27 5. YA39 24 6. YA42 13 (4) a users. Timescale of 30/11/06 has not been met. The registered person must continue to implement an effective cycle of quality assurance and ensure that the views of all stakeholders are represented. The stair carpet must be repaired or replaced so that people are safe when using the stairs. 30/10/08 24/06/08 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. 4. Refer to Standard YA6 YA6 YA9 YA20 Good Practice Recommendations The system of care planning should be simplified to make the plans easy for staff to use as working documents and to ensure people’s needs are met. New care plans should be developed for each person to ensure they are up to date and their needs continue to be met. New risk assessments should be developed for each person to ensure that they are up date and people are kept safe from unnecessary risks. A new medication cupboard should be provided that complies with the new storage requirements for controlled drugs so that the home is prepared if a person is prescribed a controlled drug. When a member of staff is employed following a POVA first check and before their CRB check a risk assessment should be conducted to ensure that people are protected from being cared for by unsuitable staff. All staff should receive equality and diversity training so they know how to recognise and meet people’s diverse needs. New staff should receive Learning Disability Award training as underpinning knowledge for NVQ’s. The thermostatic valves on taps should be serviced DS0000028201.V361597.R01.S.doc Version 5.2 Page 28 5. YA34 6. 7. 8. YA35 YA35 YA42 Heads Meadow regularly to ensure that they continue to regulate the water temperature and people are protected from being scalded. Heads Meadow DS0000028201.V361597.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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