Inspection on 19/05/08 for Holles Street Short Breaks Service

This inspection was carried out on 19th May 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Holles Street Short Breaks... 17/11/08

Similar services:

8 Thorndale Road (Homefield College)

Hunter`s Lodge

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

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

CARE HOME ADULTS 18-65 Holles Street Short Breaks Service Holles Street Worksop Nottinghamshire S80 2LJ Lead Inspector Stephen Benson Unannounced Inspection 18th May 2008 09:00 Holles Street Short Breaks Service DS0000071438.V365157.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 Holles Street Short Breaks Service DS0000071438.V365157.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. Holles Street Short Breaks Service DS0000071438.V365157.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Holles Street Short Breaks Service Address Holles Street Worksop Nottinghamshire S80 2LJ 01909 535220 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) kathryn.clark@nottscc.gov.uk Nottinghamshire County Council Mrs Kathryn Margaret Clark Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Holles Street Short Breaks Service DS0000071438.V365157.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered persons may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission are within the following category: Learning disability - Code LD. The maximum number of service users who can be accommodated is 10. N/A 1st inspection 2. Date of last inspection Brief Description of the Service: Holles Street is a care home providing support including personal care and accommodation for up to 8 younger adults who come to the home for a short break and an emergency placement for up to 2 younger adults. . The home is owned by Nottinghamshire County Council and is located in Worksop close to shops, pubs, the post office and other amenities. The home was opened in January 2008 and consists of a purpose built bungalow which has three separate units, 2 four bedded and 1 two bedded. All of the home’s bedrooms are single, and have en-suite facilities. Three bedrooms have tracking hoists fitted. The home has an enclosed garden that is well maintained and easily accessible. There is ample car parking available. The front and side entrance are monitored by close circuit television cameras. The manager said that any payments are means tested and information about the amount paid is confidential. Further information about the home is available in the Statement of Purpose and Service User Guide. Holles Street Short Breaks Service DS0000071438.V365157.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 0 star. This means the people who use this service experience poor quality outcomes. This was the first visit to the home since 1st April 2008 by The Commission for Social Care Inspection. Prior to the visit an analysis of the home was undertaken from information gathered over the last year including that from the Annual Quality Assurance Assessment they completed. . The visit centred on looking at the key National Minimum Standards for younger adults. The site visit lasted for 5 ½ hours and the main method of inspection used was called case tracking which involved selecting 3 service users and tracking the care they receive through the checking of their records and discussing this with them. Other service users were spoken with and additional records were seen. A discussion was had with the manager, staff on duty and care practices were observed. The premises were not inspected in detail but various areas of the home were visited as part of the inspection. Survey forms sent to the home by The Commission for Social Care Inspection had been completed by 5 service users and 2 relatives were seen. . What the service does well: Service users are supported to make decisions about what they do and how they spend their time. Service users are able to maintain contact with family and friends during their stay. Routines are flexible so service users can plan to spend their time the way they choose. There is a varied and wholesome diet provided and any dietary needs can be catered for. Personal support is provided in a manner, which promotes the independence of the individual service user. There are suitable arrangements to ensure that service users’ health care needs can be met whilst staying at the service. There is a system in place for service users to raise anything they are not happy about. Holles Street Short Breaks Service DS0000071438.V365157.R01.S.doc Version 5.2 Page 6 Staff are aware of the procedures to follow in order to ensure service users are safeguarded. The building is well laid out providing comfortable accommodation and allowing service users to receive the support they require. Service users are protected by the pre employment checks carried out before someone is able to come and work at the service. Staff are provided with induction, training and supervision they require to enable them to carry out their duties. A suitable qualified and experienced manager is in post to run the service. There is a system in place to receive feedback from everyone who stays for a short break at the service. Regular checks and tests are carried out on the building and equipment protect the health and safety of service users. What has improved since the last inspection? What they could do better: There must be sufficient and up to date information available about service users coming to use the short break service. Where a risk is identified to a service user or others a risk assessment must be completed. Care plans must be prepared detailing accurately how all service users needs are to be met. Staff must be aware of the needs of service users coming to the service for a short break. There should be a more varied programme of activities available to serviced users. A review must be carried out of current medication procedures to ensure service users have the correct medication during their stay and that this is stored and administered safely. A record must be made of all complaints received. Holles Street Short Breaks Service DS0000071438.V365157.R01.S.doc Version 5.2 Page 7 A written assessment must be completed to establish the required staffing level for the service. 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. Holles Street Short Breaks Service DS0000071438.V365157.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 Holles Street Short Breaks Service DS0000071438.V365157.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 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service’s assessment process has not been fully implemented resulting in patchy and incomplete assessments taking place and as a result service users needs not being properly known. EVIDENCE: It was stated on the Annual Quality Assurance Assessment (AQAA) ‘Our service is one of 4 Notts County Council Short Breaks Units. Service users who have been through the panel process and given an allocation of nights are able to visit all the establishments and choose which unit they wish to make their bookings at (unless there is a specific support need that dictates one unit over the others) People are then encouraged to make introductory visits before booking a stay. Allocations are based on extended community care assessments completed by social workers. An individual plan is then compiled based on the assessment and further information obtained from the service user, carers and other involved professionals. Holles Street Short Breaks Service DS0000071438.V365157.R01.S.doc Version 5.2 Page 10 There are 2 qualified nursing staff based at the unit who undertake specific health care assessments.’ Information provided on the AQAA stated that 13 people used the service from January 2008 to March 2008 and there have not been any placement breakdowns. They manager said that the planned system is that the service user visits the service with their carer and they sit down with a team leader and prepare the care plans. There are 2 clinical nurses who are based in the service who will assist when needed. The manager said that in practice this had not been possible to do once the service opened due to the high number of people waiting for the service to be up and running. The manager said that things were settling down now and they would be going back through all the original assessments. The manager said they were trying to do this prior to each stay but the volume is making it difficult. Staff said they had difficulty supporting one service user over the last weekend as he had dementia and they had not been aware as to how advanced this was and the person would not be coming again. As service users use the service on a regular basis throughout the year according to the number of nights they have been given, there is a system to phone up the service user’s carers and find out any changes in circumstances, medication etc that has occurred since the last visit. It as noted that this system was not always adhered to and the manager said that not all of the information gathered on the pre visit phone call is getting written down. A sample of 5 care files were seen and some of these included information gathered as part of the assessment process and the pre visit phone call, whilst others did not. There is a form to record the pre visit phone call on, however this form could be improved. There is nowhere to recorded who made the call, the date it was made on and who was spoken to. Any change in circumstances/other information does not have a space on the form and this has to be written in any gaps left. Staff said that new service users will visit with a social worker and a parent or carer. A relative commented on our survey form, ‘It is a new facitlity to our area, and is excellent in its care of the clients using it. The staff ring and check out the health issues and medication my daughter has before a stay and discuss any Holles Street Short Breaks Service DS0000071438.V365157.R01.S.doc Version 5.2 Page 11 concerns they may have with her. If I were to give them a mark out of 10 they would get 10.’ In survey forms completed by service users 4 said they were asked if they wanted to stay at the short break service and that they received information to decide if it was the right place. A service user said, “I have come here for a break whilst my sister is away on holiday, I have been before so know what it is like. Holles Street Short Breaks Service DS0000071438.V365157.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff have not had sufficient time to fully implement the care planning and risk assessments procedures. Service users’ make decisions about their lives with assistance as needed. EVIDENCE: It was stated on the AQAA that the service ‘Involve service users and other key people in the development of individual plans where possible. This includes promoting choice and independence and involvement in individual risk management strategies wherever possible.’ There were some service users leaving the service following a weekend short break and others were coming in for a short break. Staff were seen putting away care files for those leaving and getting out ones for those coming to stay. The care plan section of the care file is put in the service user’s room. Holles Street Short Breaks Service DS0000071438.V365157.R01.S.doc Version 5.2 Page 13 Staff said that this is so they can see what support a service user requires. There were 18 core care plans and those seen gave clear detail of the support required by the service user. One plan stated ’Staff to describe articles of clothing appropriate for him to choose what he wants to wear.’ It was noted that not all care plans and risk assessments had been completed. There was a record in the daily notes for one service user of inappropriate sexual behaviour, but this had not been risk assessed or a care plan prepared. Staff said they did not have enough time to get all the care plans and risk assessments done and were doing the best they could in the time available to them. Staff said there are risk assessments for going out on outings, baking, outdoor games and moving and handling. The manager said she was aware that they had not got all the care plans in place, that the system is there, but not yet embedded in due to the sheer volume of new service users coming in. The manager said staff would benefit from some training on recording. A service user said, “someone spoke to me about a care plan but I can’t remember what I was asked about it” Staff said that team leaders are responsible for preparing care plans and they involve the service user and their family. Staff said that plans need tweaking and reviewing when the service user is at the short break service to make them accurate. Staff also said that they do not get the time to read care files of services users arriving for short breaks as they are needed to support the service users. Staff said that service users are supported to make decisions about what they are doing when on their break giving examples of what activities they want to do, what food they want, when they have their meals, when they get up and go to bed and whether they want any visitors. References were seen in care plans to service users choosing a bath or shower and when to have a shave. One service user was seen having a late breakfast and others were drawing, listening to music and cutting out pictures. In survey forms completed by service users 2 said they always make decisions about what they do each day and 3 said they usually do. Holles Street Short Breaks Service DS0000071438.V365157.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users decide how they spend their time and make use of the local facilities within the limitations of the service. Service users are able to maintain family contact. Service users’ rights are respected and they enjoy their meals and mealtimes. EVIDENCE: It was stated on the AQAA that ‘As a short breaks service the main part of our role is to provide activities during the persons stay. This can be within the unit or within the local community and are based on individual choices.’ It was also stated that ‘As a new service we are only just beginning to get to know the service users who have started to stay at Holles Street. As such the choices of activities has been very limited and this needs to be developed.’ The manager said that those using the short break service come here to join in the programme of activities. The service users who have emergency Holles Street Short Breaks Service DS0000071438.V365157.R01.S.doc Version 5.2 Page 15 placements or are assessed as needing to continue to access other services, for example day centres, for continuity are supported to do so. Staff said that the activities programmes are not working as well as they want it to. Staff said the reasons for this are the staffing levels, which often don’t allow for any more than personal care tasks to be carried out and restricted access to a mini bus. This is shared with another short break service. Staff said they are not able to make suficient use of the parks nearby. The manager acknowledged there have been teething problems and said they need to look at having a better balance of high and lower needs during stays. The manager agreed a full time mini bus would allow a greater variety and frequency of activities outside of the home, but also said a shared bus is better than not having a bus at all. The manager said once they have got a better balance of needs then more activities can take place through using public transport. The manager said they have done quite a lot for a new service and always ensure that service users are able to go into the local town during their stay. There was a themed photography weekend, which had been successful. Staff also said that sometimes they are limited what they can do as service users don’t come in with sufficient money to enable them to join in activities outside of the home. A service user said, “I go walking in the gardens, they are nice”. There were references seen in care files to relatives coming to visit service users. The manager said that relatives are able to contact and sometimes help new service users settle in. Staff said that the service user and family determine what contact they will have during their stay, but they are advised to check what is happening before visiting in case their relative is involved in an activity or trip out. A Service user said, “My brother is coming to see me, I’ve got to tell him to bring an aerial for my television, he forgot it.” The manager said they try not to have any fixed routines so that Service users can plan their days to do what they want to. Mealtimes can be flexible to accommodate this. In survey forms completed by service users 4 said they do what they want during the daytime, at evening and at weekends and 1 said they do to a certain degree dependent upon the short break service’s policies. Holles Street Short Breaks Service DS0000071438.V365157.R01.S.doc Version 5.2 Page 16 It was stated on the AQAA that ‘Service Users can choose when and what they eat. .Plans are developed where people need support to eat or have specific dietary needs.’ The short break service has a 4 week rolling menu which provides a choice of dish at every meal and provides a variety of dishes including macaroni cheese, vegetable curry, tomato and pasta bake and sweet and sour chicken. There is one main meal each day, which can vary between lunch and tea time. The lighter meal has dishes such as fish finger butties, ‘choice’ on toast and sausage roll and beans. Lunch today was a choice of salad or soup with the main meal being at teatime, which was a choice of fish pie or sausage and chips. The cook prepares additional meals that are blast chilled then frozen as additional choices if someone fancies something different. The service is able to provide Kosher and Halal meals to meet some service users’ religious needs. A Service user said, “I like healthy eating, I like carrots and broccoli” and another service user said, “I have chosen my meal for today, I am having chips.” Holles Street Short Breaks Service DS0000071438.V365157.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users well being is promoted through personal and health care, but unsafe practices are being followed in managing medication. EVIDENCE: It was stated on the AQAA that, ‘Work with people as individuals based on individual needs and wishes. Personal support is provided in private and Maximum independence is encouraged. The manager said there is a need to balance out the needs of service users when coming to use the service, so that there are not too many people with high needs at anyone time. Staff said that some of the service users have very complex needs including requiring full personal care and challenging behaviour. Holles Street Short Breaks Service DS0000071438.V365157.R01.S.doc Version 5.2 Page 18 Staff said that they follow a person centred approach to providing personal support, some service users requires a prompt others need things doing for them. A service user said, “I had a bath by myself this morning, I ran the water, it was nice.” The manager said there are two nurses based at the service from Monday to Friday. They prepare health care plans and update staff on procedures. They will assist in accessing community based services as required. Staff said that service users register as a temporary resident if they are not able to see their own doctor. A Service user said, “I get all my treatment here, someone comes in to see to my leg.” The manager said that she had carried out an audit last week of the medication system and had concluded the current system needs to be reviewed. Issues she identified included medication not being provided when coming to the service and not being properly labelled. There is one service user who has bee assessed as being able to self manage her own insulin injections, but is overseen doing this by a district nurse. Part of the morning medication round was observed. There was one member of staff dispensing and administering medication and a 2nd to check this was being done correctly. During the observation it was noted that the Medicine Administration Record was signed before the medication was administered and on two occasions tablets were dropped onto the work surface and were picked up and put into the dispensing pot. One tablet has to be cut in half and a tablet cutter has just been obtained to do this with, but there was nowhere to store the left over half of the tablet until needed. The medicine fridge temperature records showed that the fridge should be kept at a temperature of between 1 – 5 degrees centigrade, however on two consecutive days this was recorded as being at 6 degrees centigrade with no action taken. Staff were seen counting all remaining medication to ensure the correct number of tablets remain. This included one jar that had over 150 tablets in. Staff said that this practice places a considerable pressure with other demands on their time. Staff confirmed that tablets have been dropped when doing this Holles Street Short Breaks Service DS0000071438.V365157.R01.S.doc Version 5.2 Page 19 Staff prepare the Medicine Administration Records from information gathered from the pre visit phone call, the care file and information on the medication packaging. Staff said they regularly have to chase up extra information to make sure they are giving the right medication. A referral has been made to the pharmacy inspection team requesting they carry out an additional visit to look at the medication systems. A Service user said, “I have to wait an hour after I take my tablets before I can have my breakfast. Holles Street Short Breaks Service DS0000071438.V365157.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints are responded to without using the complaints procedure. There are systems in place to protect residents from abuse EVIDENCE: It was stated on the AQAA that the service ‘Provide oportunities for people to express their views about our service and any issues they have.’ And that the service ‘need to improve means of ensuring that those people who have communication difficulties are able to express their concerns etc.’ Information provided on The AQAA showed that there have not been any complaints made since the service opened in January 2008. In survey forms completed by service users, 5 service users said that they knew who to speak to if they were not happy and they knew how to make a complaint. There is an easy read complaints procedure on the notice board in the entrance area. There is a complaints file to record any complaint in, but none had been recorded. It was noted in one service users daily notes that they had complained about not having any hearing aid batteries. The manager said that this had been Holles Street Short Breaks Service DS0000071438.V365157.R01.S.doc Version 5.2 Page 21 sorted out but had not been treated as a complaint through the complaints procedure. Staff said that they were aware of the complaints procedure and had reminded a relative who had raised a care issue of her right to complain but had decided not to do so. A service user when asked what they would do if not happy about something said, “I would tell my brother or sister, I would talk to one of the staff.” Information provided on The AQAA showed that there have not been any safeguarding referrals made and no safeguarding investigations have taken place. There have not been any referrals made to the Protection of Vulnerable Adults list. Staff were aware of the Adult Protection Procedures booklet, but were unable to locate it. The manager said that this should be in the team office. Staff said they would access them on line. A service user said, “I am happy here, you have to have confidence in the staff.” Holles Street Short Breaks Service DS0000071438.V365157.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users stay in a welcoming, comfortable and safe environment, which is kept clean and hygienic. EVIDENCE: It was stated on the AQAA that, ’The building is designed with the facilities and equipment to meet these standards’ The service is made up of two 4 bedded units (which staff said one was for higher dependency needs and the other for people with challenging behaviour) and one 2 bedded unit (which staff said was for emergency admissions). There have been a number of minor problem identified with the building following its completion, the manager said that some of these have been rectified and others are still ongoing. Holles Street Short Breaks Service DS0000071438.V365157.R01.S.doc Version 5.2 Page 23 There were two entries made in the maintenance book for today, one concerning a fire door not closing and the other a hoist not charging. Staff said that generally speaking the service is well laid out, but there have been a lot of teething problems. It was stated on the AQAA, ‘We have an annual contract to ensure that issues related to hazardous waste etc are addressed’. The manager said there is a cleaner employed for 25 hours a week and that night staff pick up some light tasks. The manager said she needs to make arrangements for a relief to cover when the cleaner is not at work. In survey forms completed by service users 4 service users said the service is always fresh and clean and 1 said it usually is. Staff said the infection control nurse had trained some staff and was coming back to do the rest. A service use said, “My room is clean”. Holles Street Short Breaks Service DS0000071438.V365157.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service cannot demonstrate that there are sufficient staff on duty to meet the needs of the service users and the objectives of the short break service. EVIDENCE: It was stated on the AQAA that one plan for improvement over the next 12 months is to ‘Develop a pool of relief staff to reduce the relience on agency staff.’ The rota showed that there is 1 team leader ands 3 care staff on duty during the day and 2 staff on duty overnight. Staff said that they have a lot of agency staff working in the home. Staff identified a number of problems they faced by the current staffing arrangements, which they do not view as adequate. This included not having time to prepare care plans and risk assessments, not having time to read care plans including for service users arriving for a short break and do not have time to follow the sort of activities programme they are expected to provide. Holles Street Short Breaks Service DS0000071438.V365157.R01.S.doc Version 5.2 Page 25 The team leaders said they have insufficient time to fulfil their management and administrative duties, including providing supervision to care staff due to the amount of time they have to spend providing direct support to service users. During the last weekend, when the serviced was full with 10 serviced users there was not a cook or cleaner on duty so these duties had to be covered by the care staff. The staffing levels have not been varied to take into account a difference in the number of service users in the service at a particular time. They remain the same whether there are four or ten service users. The manager said there was not an assessment completed demonstrating service users needs are being met by the current staffing levels. In survey forms completed by service users they all said they are treated well by staff, who act on what they say. A service user said, “They are nice people.” It was recorded on The AQAA that all people who have worked in the service have had satisfactory pre employment checks. Staff files seen showed that the correct recruitment practices are followed. The service follows Nottinghamshire County Council’s equal opportunities policy in the recruitment of new staff. Information provided on The AQAA showed that there are 5 permanent care staff who have National Vocational Qualification level 2 or above, no others are currently working towards one of these. There were induction and supervision records seen for staff, who said that team leaders often have to stay behind after their shifts to provide this. The manager showed a training plan, which included training planned for health and safety, safeguarding adults, medication and the Mental Capacity Act. Holles Street Short Breaks Service DS0000071438.V365157.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a suitably qualified and experienced manager in post. Service users are able to comment on their experiences when using the service. The health, safety and welfare of service users are promoted and protected. EVIDENCE: The manager was in post for the opening of the short break service and has previously managed other residential services within Nottinghamshire County Council. The manager has social work qualification and has completed the Registered Managers Award. Holles Street Short Breaks Service DS0000071438.V365157.R01.S.doc Version 5.2 Page 27 The manager was described as supportive and being a good manager by staff. There was a post stay monitoring form, which all service users are asked to complete following a stay at the service. The manager aid these will be gone through to see what is enjoyed and what can be improved. The manager said that carers meetings are up and running and she intends to start service user meetings in due course. The manager said that all the required health and safety checks are carried out at the required frequency and there are service contracts in place for servicing all the equipment. Dates of tests were recorded in the AQAA showing they are regularly carried out. A sample of these were looked at and found to be correct. Staff were seen carrying out maintenance checks, including on fire safety equipment and hoists. Holles Street Short Breaks Service DS0000071438.V365157.R01.S.doc Version 5.2 Page 28 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 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 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 1 33 X 34 3 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 2 13 3 14 X 15 X 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 X 3 X 3 X X 3 X Holles Street Short Breaks Service DS0000071438.V365157.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No (First 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 YA2 Regulation 14(1)(a) Requirement There must be sufficient and up to date information available about service users coming to use the short break service. Where a risk is identified to a service user or others a risk assessment must be completed. Care plans must be prepared detailing accurately how all service users needs are to be met. Staff must be aware of the needs of service users coming to the service for a short break There should be a more varied programme of activities available to serviced users A review must be carried out of current medication procedures to ensure service users have the correct medication during their stay and that this is stored and administered safely. A record must be made of all complaints received A written assessment must be completed to establish the required staffing level for the service Timescale for action 01/07/08 2 3 YA6 12 (1)(a) 15(1) 01/06/08 01/09/08 YA6 4 5 6 YA6 YA12 YA20 15(1) 16(2)(n) 13(2) 01/06/08 01/08/08 01/07/08 7 8 YA22 YA32 17 (2) 18 (1)(a) 01/06/08 01/07/08 Holles Street Short Breaks Service DS0000071438.V365157.R01.S.doc Version 5.2 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Holles Street Short Breaks Service DS0000071438.V365157.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection East Midland Regional Office Unit 7 Interchange 25 Business Park Bostocks Lane Nottingham NG10 5QG 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 Holles Street Short Breaks Service DS0000071438.V365157.R01.S.doc Version 5.2 Page 32 - 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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