Inspection on 14/05/07 for HFT 34 Shipston Road

This inspection was carried out on 14th May 2007.

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

The inspector found 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

HFT 34 Shipston Road 09/05/06

HFT 34 Shipston Road 12/01/06

HFT 34 Shipston Road 05/09/05

HFT 34 Shipston Road 17/03/05

HFT 34 Shipston Road 16/11/04

HFT 34 Shipston Road 26/03/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 HFT 34 Shipston Road 34/36 Shipston Road Stratford On Avon Warwickshire CV37 7LP Lead Inspector Martin Brown Key Unannounced Inspection 14th May 2007 10:45 HFT 34 Shipston Road DS0000004242.V335291.R02.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 HFT 34 Shipston Road DS0000004242.V335291.R02.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. HFT 34 Shipston Road DS0000004242.V335291.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service HFT 34 Shipston Road Address 34/36 Shipston Road Stratford On Avon Warwickshire CV37 7LP 01789 261105 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.hft.org.uk Home Farm Trust Mrs Penelope M Barry Care Home 9 Category(ies) of Learning disability (9) registration, with number of places HFT 34 Shipston Road DS0000004242.V335291.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Penelope Barry must achieve the Registered Managers Award before 31 October 2006 Date of last inspection Brief Description of the Service: 34/36 Shipston Road is close to the centre of Stratford upon Avon, which has a wide range of shops, leisure facilities and medical services. The home provides care and support services to adults with learning disabilities. The home consists of two large semi-detached houses, each having their own separate entrances and staff team. The houses provide small group accommodation, with each house having a lounge, dining room, kitchen and laundry. All bedrooms are single rooms. There are no en-suite bedrooms, and wash hand basins are not provided in peoples bedrooms. The two houses share a sleep in member of staff, who is based in one house. Residents in the other house are able to access the sleep in staff via a direct dial telephone. There is a large car parking area at the front of the properties and there is a large, well maintained shared garden at the rear of the property. Information provided by the manager, reports that the range of fees charged at the home currently varies between £565 and £717 per week dependent on individuals assessed needs. This is currently under review. Residents are required to pay admission costs for activities and entertainments and to make a contribution to their holidays (staffing costs) in some cases where this is expensive. Service users are also expected to pay for their hairdressing, private chiropody toiletries and clothing, (although the manager reports that some clothing is also currently provided by the home). HFT 34 Shipston Road DS0000004242.V335291.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that started at 10.45am on a weekday and finished at 4.45pm. All the residents were spoken with, as were the manager and staff on duty. Policies and procedures and care records were examined, and four residents were ‘case tracked’, that is, their experience of the service provided by the home was looked at in detail. The pre-inspection questionnaire returned by the manager also informed the inspection. Inspection questionnaires and surveys had been sent out to residents and relatives. Four questionnaires were received back from relatives, and eight received from residents. All those received from residents were completed with the assistance of staff at the home. What the service does well: The service continues to provide warm, friendly domestic-scale homes where people can develop social and self-help skills, supported by a small, consistent and experienced staff team who are familiar with them and with whom they are familiar and comfortable with. Questionnaires returned prior to the inspection showed a high of satisfaction from both residents and relatives, with comments such as ‘the staff are hard-working and dedicated’ and ‘they always have (residents’) best interests at heart’. Staff were seen to be helping residents confidently tackle such self-help skills such as cooking and cleaning, and residents were seen to take a high level of pride and satisfaction in organising such things as sandwich preparation for lunches for the next day. Residents spoke enthusiastically of activities they were involved in, (with some prompting and support from staff at times, where memory or articulation was problematic). Evening clubs, drama productions, and visits to and by friends evidenced a busy social life for individuals where wished. The service showed it was supporting the sometimes difficult area of personal relationships with sensitivity. HFT 34 Shipston Road DS0000004242.V335291.R02.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Details of any allergies must be recorded on Medication Administration Record Sheets to help ensure that residents’ medication is always administered safely. Elements of residents’ contracts, particularly that relating to the costs of holidays and activities, should be made easier to understand. Staff at Shipston Road are all part of a small, consistent, and experienced team who know the residents well. There is a risk that information is known, but not recorded, and may consequently be ‘lost’, or not readily known to any new staff unfamiliar with the residents and their needs. The service should ensure that all information concerning individual risks is clearly and accessibly recorded. Some cupboards and doors are locked at times because of the needs of particular residents. This places restrictions on other residents. the home should try to minimise these restrictions as far as possible. The service should ensure that it has clear guidelines in place to respond appropriately to any violent incident, and also that everyone has a clear understanding of what constitutes ‘restraint’. Questionnaires returned by residents and some relatives, whilst extremely positive, indicated a wish for more staffing at weekends. It is understood that there has been a recent shortfall in staffing and that this will soon be resolved. The problem most frequently referred to was that residents could not go out without staff to support them. Further work on helping residents to safely go out independently may be an area the service could usefully explore, although it is acknowledged that there have been difficulties in this area previously. HFT 34 Shipston Road DS0000004242.V335291.R02.S.doc Version 5.2 Page 7 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. HFT 34 Shipston Road DS0000004242.V335291.R02.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 HFT 34 Shipston Road DS0000004242.V335291.R02.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): 2,5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is no reason to suppose that the individual aspirations and needs of prospective residents will not be fully assessed as they have been previously. Elements of individual contracts, particularly those concerned with costs of holidays and other leisure activities, are too complicated to be readily understood by residents. EVIDENCE: All of the service users living in both houses have been together for several years and no new people have moved into the home since the last inspection. The manager explained that people only move into the home after a thorough assessment and that they are provided with opportunities to visit the home beforehand. The assessment procedure has been looked at on past inspections and found to be good. Well-detailed assessments were seen to be in place on peoples files. Residents have individual contracts that are produced in a ‘service user friendly’ format, with large print and pictures, designed to make it easy to understand. However, some of the detail, particularly in relation to staffing and HFT 34 Shipston Road DS0000004242.V335291.R02.S.doc Version 5.2 Page 10 holiday costs, is very complicated and not easy to understand. The manager agreed that this needed to be simplified. HFT 34 Shipston Road DS0000004242.V335291.R02.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ needs and goals are supported by a service where staff are familiar with these and where there is a good awareness of risks and where residents are supported in choices. The service needs to be vigilant to ensure that choices are not unduly restricted, and to ensure that known risks and their management are always recorded, rather than purely relying on staff experience and knowledge. EVIDENCE: All residents have regularly reviewed individual care files and person-centred plans. These are kept in separate folders, with care files concentrating on health needs, risk assessments and formal reviews and appointments, whilst person centred plans concentrate on future plans and wishes and memorable life experiences. Noted in these were one person’s expressed wish for a holiday in Australia, with details of that country and what could be expected there. HFT 34 Shipston Road DS0000004242.V335291.R02.S.doc Version 5.2 Page 12 Person centred plans included photographs of recent holidays and other enjoyable experiences. The manager advised that residents enjoyed working on Person centred plans, and gave an example of a recent ‘Circle of Support’ meeting where the resident got much more from a meeting centred around her wishes that used to be the case with review meetings. Much of the userfriendly details concerned holidays; the manager acknowledged that more work may be needed to detail the more day-to-day aspects of life, such as independence skills, in a more ‘user friendly’ way. Some details of care plans, such as a reference to a pet that had since died, were out of date. The manager advised that these were currently being up-dated. The manager advised that all residents, bar one, had expressed a wish for a holiday in Florida, and this was being arranged for later in the year. Several residents spoke of this forthcoming holiday. The person who did not wish to go also made this clear. The manager advised that person–centred plans and reviews, and observations had shown that some residents may have long term aspirations to live more independently, but that equally, many of the residents had expressed a definite wish to remain living as a group, in the home. Several residents were keen to tell me that they liked living at Shipston Road. Most of the residents were out for much of the day. The two residents at home indicated that they were enjoying their day. They did personal chores, such as tidying their room, helped with chores such as washing up and preparing their lunch, and enjoyed individual staff attention in the house. There are timetables of daytime and evening activities and personal chores, and residents all appeared to be happy with these. Many residents spoke enthusiastically of various activities, and were seen to be happily engaging in communal or individual tasks such as cooking, washing up or making drinks, with staff support according to confidence and current abilities. Only one person had complained, via the questionnaire, of doing ‘chores’ and this person was keen to show me around and discuss music and films before the evening meal, whilst others were happily doing the necessary chores to keep the home running. This was not a source of friction on this occasion, and there was no suggestion that any coercion was ever involved. The manager advised that it is part of the service’s philosophy that people partake in chores as part of developing personal self-help and independence skills. She agreed that it may be beneficial to highlight these expectations in individual contracts, the Service User Guide, and the Statement of Purpose. Risk assessments were seen to be in place in individual care plans and communally where general risks, such as safety and security within the home, were managed. There is a consistent staff team, with little use of staff unfamiliar with residents, so that staff are familiar with the needs and abilities of residents. One resident was chopping food, ably assisted by a member of HFT 34 Shipston Road DS0000004242.V335291.R02.S.doc Version 5.2 Page 13 staff. Risk assessments did not appear to cover this activity, although observation showed it was being done in a competent manner, and discussion with staff and management confirmed that it was not an activity that would be undertaken with support of staff unfamiliar with that person’s needs. The manager advised that because staff are so familiar with residents and their needs, management of risks may sometimes be instinctive, and not fully recorded. She acknowledged that this may not be helpful for any newer staff. There is a folder outlining the most notable risks and guidelines for the wellbeing of residents, for any staff not familiar with them. There are some locked cupboards, because some residents may take things, generally food, inappropriately. This, the manager agreed, may be restrictive on other residents, who were able to exercise responsibility in such matters. This, the manager advised, was an unfortunate consequence of people with differing needs living communally, but she agreed that ongoing work was needed to avoid restricting access within people’s own home unnecessarily. HFT 34 Shipston Road DS0000004242.V335291.R02.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents enjoy good support with activities in the home and in organised activities outside the home. There is potential for more work to be done to support resident being independent outside the home. The home supports residents in establishing and maintaining relationships with people outside the home. EVIDENCE: Residents were all either observed to be busy and fulfilled in a variety of activities, or told me about the variety of activities that they did. One resident told me about her part-time work in a café, another told of the different people she invited for tea. Several attend a drama class, and photos of past productions were seen. Others spoke of different clubs, and of holidays past and present. Some of this was done with staff prompting and support, as several residents had difficulty in remembering or articulating details. One resident informed that she was a stand up comedian, told me some jokes, and HFT 34 Shipston Road DS0000004242.V335291.R02.S.doc Version 5.2 Page 15 decided that the ones I told her in exchange were rubbish, or words to that effect. The service is situated by a busy road that leads into the centre of Stratford. While this is convenient for walking, safety concerns for those not fully skilled in road safety awareness means that independent travelling, even to a local shop, is limited. Deficits in social skills and awareness also make some people vulnerable in using local facilities such as shops. Consequently, residents are currently limited in respect of going out without staff. A variety of difficulties and vulnerabilities were evident; these were discussed by staff and were recorded in individual files and risk assessments. Consequently, residents tend to be limited to events outside the home where staff or other support is available. This led to comments in questionnaires that sometimes there is less to do at weekends. This was not evident in discussions with residents. The manager advised that there had been staffing at minimum levels at weekends on occasions, but that residents may also note a contrast between very busy weekdays and quieter weekends, particularly when some residents go to visit or stop with parents. The manager and staff were able to demonstrate, supported by records, how relationships were supported, with outside help and advice being sought and used when issues such as consent caused challenges for all. Examples discussed showed that the service worked well to steer a sensitive and supportive path in some potentially difficult areas. Lunch was shared with those residents at home, and was a relaxed and chatty time. Residents were later seen to be taking part in preparation for the evening meal, each contributing according to their abilities and wishes. Those in 36, in particular, were seen to be particularly active and enjoying being part of the cooking and preparation. Menus show a variety of healthy meals being provided to meet a variety of wishes. HFT 34 Shipston Road DS0000004242.V335291.R02.S.doc Version 5.2 Page 16 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. This judgement has been made using available evidence including a visit to this service. Residents continue to be supported by the service in having personal, physical, emotional and health needs met. Medication administration is safe, but may benefit from being organised slightly differently so as to better meet the needs of people in both houses. EVIDENCE: Residents were seen to be helped and encouraged in tasks, as well as in remembering events and plans. Residents and staff were seen to be interacting in a warm, friendly manner, and residents were positive about staff in their remarks. One questionnaire received from a relative noted the ‘good rapport between staff and residents’. As noted in the previous inspection, residents continue to have good access to outside specialists when required, and health needs continue to be met. One person has a monitor in her room that is able to monitor for epilepsy but does not intrude on her privacy, as it is only alerted by movements associated with seizures, rather than by any sound. Another person also has a monitor. HFT 34 Shipston Road DS0000004242.V335291.R02.S.doc Version 5.2 Page 17 There is appropriate outside support and involvement in supporting residents with behaviour-related needs. An example was given of how staff reactions to one person have now changed to a consistent, response guided by an outside professional that is starting to show positive results. Good examples of the service’s support to individuals was seen in discussion of how particular residents were supported in relationships with people outside the home. Medication administration and recording was checked, and all procedures and protocols explained satisfactorily by a member of staff. Medication given was seen to be recorded accurately, and sample checks showed that stock control and recording of stock was accurate. Individual Medication Administration Record Sheets have a space for ‘allergies’. This was blank. The manager advised that she would ensure this was appropriately filled in future, either by the pharmacy, or by staff at Shipston Road. All medication is currently done at the house where the medication is kept. This means that residents from the other house must come round to collect medication, putting additional pressure on the staff concerned, as well as compromising residents’ independence and dignity. The medication involved is relatively ‘low level’, and possibilities of having this medication and its administration based in the relevant house was discussed with the management. HFT 34 Shipston Road DS0000004242.V335291.R02.S.doc Version 5.2 Page 18 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 good. This judgement has been made using available evidence including a visit to this service. Residents can be confident that their concerns are listened to and acted upon, and that the service will protect them from abuse, neglect and self-harm. The service is fully prepared and able to call on outside advice and assistance when necessary. EVIDENCE: The home has recorded a number of complaints in the past year, principally concerning residents being unhappy at aspects of other residents’ behaviour. Typical examples of these were of another resident shouting, and of a resident ‘hogging the phone’. The manager advised that these examples of the occasional stresses of people living communally, and during my visit, residents did not show or express any signs of being unhappy with one another’s company. The manager advised that the complaint regarding the phone had resulted in a resident getting her own phone, to avoid her ‘hogging’ the phone in the house. Staff spoken to demonstrated a good understanding of abuse, and of what action to take in the event of it being witnessed, reported or suspected. They were clear on what immediate action they should take in the event of a violent incident as below, in order to make residents safe, but less clear on the appropriate response in then whether to involve involving other agencies. There had been occasions in the past year in which a resident had been violent towards other residents. Outside professional support was being used to try HFT 34 Shipston Road DS0000004242.V335291.R02.S.doc Version 5.2 Page 19 and resolve these issues and to ensure the safety and well-being of all the residents. Whilst good preventative strategies were being introduced, there was some uncertainty within the service as to what action to take following any violence, in respect of contacting other agencies, such as the police. The need for a clear procedure for staff to follow, depending on the type and level of the violence, was discussed with staff and management. There had been a complaint made by a resident concerning a member of staff. The manager was able to demonstrate that this had been dealt with suitably, with appropriate action being taken, including a referral to the Vulnerable Adults team, and the involvement of an independent advocate to support the resident. HFT 34 Shipston Road DS0000004242.V335291.R02.S.doc Version 5.2 Page 20 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. This judgement has been made using available evidence including a visit to this service. Residents benefit from living in homely, comfortable, and safe, small-scale environments that are clean and hygienic. EVIDENCE: The service functions as two separate house with a joint back garden, one office, and one sleeping-in room. This enables the service to work on a smaller, more ‘homely ‘ scale, with two separate households, one of four residents plus staff, and one of five residents plus staff. There are pleasant communal areas, comprising of lounge, dining room and kitchen, with single bedrooms, shared toilets, bathroom and shower. 36 Shipston Road was seen to be very tidy. Staff advised that the residents there are very tidy-minded, and like to have everywhere spotless, and see to it that it is. Number 34 was less tidy; staff advised that more staff support is required here, and that cleaning was sometimes a more gradual process. The untidiness related to bits of paper and a paper towel bins needing emptying, HFT 34 Shipston Road DS0000004242.V335291.R02.S.doc Version 5.2 Page 21 rather than any underlying accumulation of dirt or long-term lack of cleanliness, and identified areas were much tidier later in the inspection. The environment appeared generally well-maintained, with refurbishment taking place to keep pace with wear and tear. Carpets are in need of replacement, as noted previously, but the manager advised that this is about to happen, and that residents have been involved in choosing new ones. The two residents asked about this could not recall doing so, but it is acknowledged that they may well have done so but forgotten. Bedrooms were seen to be tidy and personalised. Residents were happy for me to look in them, two actively wished to show me them. One room has bands of frosted glass across it for privacy, as its occupant does not wish for curtains and blinds. Laundry areas were seen to be clean and tidy and suitable for current purposes. Good hygiene practices noted in the previous inspection continue. The laundry is accessed via the kitchen but service users are not allowed to carry any laundry through the kitchen when food is being prepared, to avoid any possibility of food contamination. Service users are encouraged to take part in cleaning the kitchen and other areas of the home, and this was seen to happen, with staff support as necessary. One laundry room was locked when staff are not directly available, as I was advised that one person uses the laundry in an unsuitable way, by somehow removing washing from the machine before it has finished. . There is a large, well-maintained garden that is used by both houses. The garden paving had been levelled to make it more accessible. There is garden furniture and a large grassed area to make it a useful amenity in good weather. Residents said they enjoy being out there in the summer. HFT 34 Shipston Road DS0000004242.V335291.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35, Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a suitably recruited and trained staff team, who are familiar with their needs and how to meet them. Some clarification amongst staff on what constitutes ‘restraint’ may ultimately benefit residents. EVIDENCE: Residents all appeared at ease and relaxed with staff, who showed a good understanding of their needs and wishes. The rota shows a consistent pattern of familiar staff. Staff were observed supporting residents in a positive, reassuring and encouraging manner, and adhering to agreed guidelines where these had been brought in to support or minimise particular behaviours. This was seen, to take one example, in response to one person’s tendency to want to hug people inappropriately. A sample of three staff records were examined and these showed good recruitment, induction and training and supervision processes in place. As confirmation of a satisfactory Criminal Records Bureau check, there was a photocopy of the front page of the certificate. The manager was advised that HFT 34 Shipston Road DS0000004242.V335291.R02.S.doc Version 5.2 Page 23 signed, dated confirmation that a satisfactory Criminal Records Bureau check has been seen, with the number of the check, by a responsible person within the organisation, should be available, if the full original (not a photocopy) check is not there. The inspector has since been advised that the current system operated by the home is acceptable. Staff were able to show, when asked, a good awareness of managing challenging behaviour, issues of abuse, and good procedures and practices in respect of medication and fire safety. Staff spoken to commented that ‘HFT were very good at training’ and the number of copies of training certificates in individual files backed this up. The Pre Inspection Questionnaire completed by the manager stated that half the staff team have National Vocational Qualification at least to level 2. One staff spoken to had just been on Mental Capacity Training, in readiness for the potential impact of the Mental Capacity Act. A staff member said that the home operated a ‘no restraint’ policy, but discussion established that restraint would be used where a duty of care meant that staff would for example, stop someone burning themselves on a cooker or crossing a road in front of traffic. Staff were less clear what level of restraint would be involved in making one person safe in the event of an assault by another, other than ‘getting them to a safe place’. There is one male staff; the manager was clear that he did not provide personal care for female residents, in line with Home Farm Trust policy. HFT 34 Shipston Road DS0000004242.V335291.R02.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well-run by a competent experienced manager, who will shortly complete her Registered Manager’s Award. Quality assurance systems are now in place, enabling residents and relatives views to better inform the future development of the service. Fire procedures to help ensure safety in the home are understood by staff and residents. EVIDENCE: The manager has 20 years experience working in social care services and has been working for Home Farm Trust, a provider of services to people for learning disabilities, for over ten years. She is supported by a senior care HFT 34 Shipston Road DS0000004242.V335291.R02.S.doc Version 5.2 Page 25 worker. The manager advised that she is still in the process of completing the Registered Manager’s Award, says she is three quarters of the way through it, and hopes to complete it by the end of September. The manager advised that quality monitoring now takes place to ascertain the views of residents. Results of these were seen. The questionnaires are completed with the help of staff from day services. Relatives are contacted on an individual basis. Evidence of recent ‘Regulation 26’ monitoring visits by the Registered Provider were seen. Person Centred Plans are now in place. A sample of these were seen. The manager advised that the results of these showed that most residents were very clear that they wished to remain at the home, with one person varying in this view on differing occasions, and one person wishing to remain at the home, but on her own. The manager advised that where people expressed dissatisfaction with their current living arrangements, either directly, or by their actions, then outside professionals are involved in further work. This was seen in individual records. A discussion was had with the manager as to whether future quality assurance questionnaires would be more beneficial by being more closely tailored to the direct experience of people in 34/36 Shipston Road. Questionnaires returned by relatives in advance of this inspection showed people a high level of satisfaction and included comments such as ‘staff very dedicated’ ‘always have (resident’s) interests at heart’. Relatives commented that staff were helpful not just to residents, but to relatives as well. One possible area of improvement noted was to have ‘sufficient staff on at weekends’. This person noted that sickness sometimes meant staff had ‘to cope with both houses.’ This was something noted in several responses by residents, with half those responding feeling that they could benefit from more staff at weekends to help them with activities outside the home. Four residents commented on the question ‘can you do what you want at the weekend?’ that they were restricted by staffing shortages. ‘ We can’t always do what we want because there aren’t enough staff.’ and ‘it depends if we have enough staff’ were two comments. This has been discussed earlier in the report, under ‘lifestyle’. Fire and general safety was discussed with staff and with residents. Records and discussion with staff and residents showed that regular fire drills and tests take place. Responses showed a good and consistent awareness of what to do to ensure safety. The Pre Inspection Questionnaire returned by the manager showed all safety checks as up-to-date, and the inspection showed no apparent infringements of good health and safety practice. HFT 34 Shipston Road DS0000004242.V335291.R02.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 3 3 x 4 x 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 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 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 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 2 x 3 x 3 x x 3 x HFT 34 Shipston Road DS0000004242.V335291.R02.S.doc Version 5.2 Page 27 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 YA20 Regulation 13 (2) Requirement Details of any allergies must be recorded on Medication Administration Record Sheets, to ensure that anyone administering medication is aware of these. Timescale for action 30/06/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 Refer to Standard YA5 YA7 YA7 YA9 YA20 Good Practice Recommendations Details of holiday costs in individual contracts should be made simpler so that they can be more readily understood by all. It should made clearer that the development of self-help skills is part of the ethos of 34-36 Shipston Road. The locking of certain areas should be reviewed to try to ensure that some residents’ freedoms are not unduly restricted because of the needs of others. All significant risks should be assessed in writing so that their management is not over–reliant on staff experience and knowledge. Safe ways should be considered in which to hold and administer current medications in both homes, to save DS0000004242.V335291.R02.S.doc Version 5.2 Page 28 HFT 34 Shipston Road 6 7 YA23 YA35 residents having to visit ‘next door’ to get medication. There should be a clear procedure to guide staff on what to do following a violent incident, so that a consistent and proportionate response is made. There should be clearer direction to help staff have a greater understanding on what constitutes ‘restraint’ and under what circumstances it may be acceptable HFT 34 Shipston Road DS0000004242.V335291.R02.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI HFT 34 Shipston Road DS0000004242.V335291.R02.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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