Inspection on 09/08/07 for Homeville

This inspection was carried out on 9th August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Homeville 17/06/08

Homeville 10/08/06

Homeville 06/02/06

Homeville 20/06/05

Homeville 22/02/05

Homeville 14/05/04

Homeville 13/02/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME MIXED CATEGORY MAJORITY ADULTS 18-65 Homeville Homeville 95 Victoria Road Margate Kent CT9 1RD Lead Inspector Jenny McGookin Key Unannounced Inspection 10:05 9th August 2007 Homeville DS0000023224.V345823.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 Homeville DS0000023224.V345823.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 Older People and 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. Homeville DS0000023224.V345823.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Homeville Address Homeville 95 Victoria Road Margate Kent CT9 1RD 01843 223455 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) Mr Paul Rollins Jolene Kelly Rollins Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Homeville DS0000023224.V345823.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th August 2006 Brief Description of the Service: Homeville is a terraced property with accommodation on three floors. It is situated in close proximity to the local shops, park, bowling alley and other public amenities. Single room accommodation is provided for both service users. There is registered manager and the Home employs a team of support workers. They work a rota that includes one staff member on sleep-in duty at night, further staff are available on-call in the event of an emergency. The aim of the Home is to provide a family environment that will enable them to settle and integrate within the community and to become accepted and valued as individuals. Information on the range of fees was not available at the time of issue of this report. Information on the home’s services and the CSCI reports for prospective service users will be detailed in the Statement of Purpose and Service User Guide. There was no available e-mail address for the home. Homeville DS0000023224.V345823.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection site visit, which was intended to review findings on the last inspection (August 2006) in respect of the day-to day running of the home; and to check compliance with matters raised for attention on that occasion. The inspection process took just over eight hours, and involved meeting with the registered manager and four support workers. Neither of the service users was able or (in one case) inclined to interact meaningfully and remained so throughout the day. Interactions between staff and service users were observed, particularly over lunchtime. The inspection involved a review of the premises and a range of records. Both service users files were examined in detail along with all available personnel files. Both bedrooms were inspected for compliance with the National Minimum Standards along with all the communal facilities What the service does well: What has improved since the last inspection? Staffing levels have benefited by the introduction of back-up support staff, one of whom has also taken over the management of the maintenance of the property, to good effect. Homeville DS0000023224.V345823.R01.S.doc Version 5.2 Page 6 Care plans now pointedly cross-refer the reader to risk assessments and behaviour guidelines, to ensure a fully rounded approach. What they could do better: 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. Homeville DS0000023224.V345823.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Individual Needs and Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Conduct of Management of the Home Scoring of Outcomes Statutory Requirements Identified During the Inspection Adults 18 – 65 (Standards 1–5) (Standards 6-10) (Standards 11–17) (Standards 18-21) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37-43) Older People (Standards 1–5) (Standards 7, 14, 33 & 37) (Standards 10, 12, 13 & 15) (Standards 8-11) (Standards 16-18 & 35) (Standards 19-26) (Standards 27-30 & 36) (Standards 31-34, 37 & 38) Homeville DS0000023224.V345823.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 (Adults 18 – 65) and Standards 1 – 5 (Older People) are: 1. 2. 3. Prospective service users have the information they need to make an informed choice about where to live. (OP NMS 1) Prospective users’ individual aspirations and needs are assessed. No service user moves into the home without having been assured that these will be met. (OP NMS 3) Prospective service users’ know that the home that they choose will meet their needs and aspirations. Service Users and their representatives know that the home they enter will meet their needs. (OP NMS 4) Prospective service users’ have an opportunity to visit and “test drive” the home. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. (OP NMS 5) Each service user has an individual written contract or statement of terms and conditions with the home. Each service user has a written contract/statement of terms and conditions with the home. (OP NMS 2) 4. 5. The Commission considers Standard 2 (Adults 18-65) and Standards 3 and 6 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome are is good This judgement has been made using available evidence including a visit to this service. These standards were not assessed on this occasion, except in respect of one matter raised for attention at the last inspection. EVIDENCE: The home’s revised Statement of Purpose, Service User Guide and contract were not submitted for assessment against the National Minimum Standards in time for inclusion in this report. The home will need to evidence their issue to interested parties and whether other formats are warranted, or their nonprovision will need to be justified by properly documented assessments. The manager was able to demonstrate that one matter raised for attention at the last inspection in respect of the contract had been addressed. Homeville DS0000023224.V345823.R01.S.doc Version 5.2 Page 9 Both current service users were admitted in 2000/1 i.e. before the provisions of the National Minimum Standards (hereafter referred to NMS) became applicable and their admissions were, therefore, not assessed against the NMS on this occasion. Information indicates that the current service users’ admissions had been managed effectively and that both service users had settled down together remarkably well. The company has decided not to fill the vacancy which currently exists, because of anticipated disruption. The last inspection found that there was a revised pre-admission assessment in place in readiness, if this situation changes, and its application will be assessed accordingly. Information on action taken to address one matter raised by the last inspection, and in the absence of information to the contrary, would indicate that the last inspection’s quality rating of “good”, should still stand. Homeville DS0000023224.V345823.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6-10 (Adults 18-65) and Standards 7, 14, 33 & 37 (Older People) are: 6. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. The Service Users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users make decisions about their lives with assistance as needed. Service Users are helped to exercise choice and control over their lives. (OP NMS 14) Service users are consulted on, and participate in, all aspects of life at the home. The home is run in the best interests of service users. (OP NMS 33) Service users are supported to take risks as part of an independent lifestyle. The service users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users know that the information about them is handled appropriately and that their confidences are kept. Service Users rights and best interests are safeguarded by the home’s record keeping, policies and procedures. (OP NMS 37) 7. 8. 9. 10. The Commission considers Standards 6, 7 and 9 (Adults 18-65) and Standards 7, 14 and 33 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome are is good This judgement has been made using available evidence including a visit to this service. 6, 7, 8, 9, 10 Individuals benefit from being involved in decisions about their lives, and play an active role in planning the care and support they receive. EVIDENCE: The format of this home’s care planning processes should enable all aspects of their personal and health care, as well as their social care needs to be addressed. The plans are properly underpinned by a wide range of risk assessments covering each individual, their activities and environments (on Homeville DS0000023224.V345823.R01.S.doc Version 5.2 Page 11 and off site) as well as behaviour guidelines and triggers. Since the last inspection, the manager has introduced more pointed cross-referencing in these documents, to ensure a fully rounded approach. Staff are required to countersign any changes or updates in the care plans as evidence of having read and agreed to comply with their provisions. Monthly meetings are used to review and extend their scope. This is judged careful practice. Formal care plan reviews tend to be lead by placing authorities every six months, and records confirm that these routinely invite all interested parties (service users, relatives, community nurses, care managers) as well as the home’s staff so as to be fully inclusive. The home needs to demonstrate that it takes more control over the formal care plan reviews. There was evidence of the manager producing reports on her own six-monthly “baseline reviews” as part of this process. This is judged thorough. Record keeping was judged systematic and open to inspection by anyone authorised to do so. The home’s arrangements for keeping confidential information secure against unauthorized access was judged satisfactory. Cabinets are lockable and computerised records are password protected. Homeville DS0000023224.V345823.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 (Adults 18-65) and Standards 10, 12, 13 & 15 (Older People) are: 11. Service users have opportunities for personal development. Service Users find the lifestyle experienced in the home matches their expectations and preferences and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users are able to take part in age, peer and culturally appropriate activities. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users are part of the local community. Service users maintain contact with family/ friends/ representatives and the local community as they wish. (OP NMS 13) Service users engage in appropriate leisure activities. Service users find the lifestyle experienced in the home matches their expectations and preferences and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users have appropriate personal, family and sexual relationships and maintain contact with family/friends/representatives and the local community as they wish. (OP NMS 13) Service users’ rights are respected and responsibilities recognised in their daily lives. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users are offered a (wholesome appealing balanced) healthy diet and enjoy their meals and mealtimes. Service users receive a wholesome appeaing balanced diet in pleasing surroundings at times convenient to them. (OP NMS 15) 12. 13. 14. 15. 16. 17. The Commission considers Standards 12, 13, 15, 16 and 17 (Adults 1865) and Standards 10, 12, 13 and 15 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome are is good This judgement has been made using available evidence including a visit to this service. 11, 12, 13, 14, 15, 16, 17 Homeville DS0000023224.V345823.R01.S.doc Version 5.2 Page 13 Service users benefit from the supported they receive to make choices about their life style, and to develop their life skills. Social, educational, cultural and recreational activities meet individual’s assessed needs and expectations. Service users benefit from the provision of a nutritious and varied diet. EVIDENCE: Abilities, activities and personal preferences are identified in care plans and promoted by day-to-day consultation or interpretation (where the two service users do not have sufficient verbal skills) thereon. Both service users have been attending Thanet College for developmental and recreational courses in things like cooking, arts and crafts sessions, drama, and yoga – with more in prospect. One service user’s certificates of achievement were on display in his bedroom. They also attend clubs and pubs for a range of social events not necessarily identifiable with or restricted to their learning disabilities such as Karaoke sessions. Recent attempts to engage in council run sailing and biking clubs were frustrated, but staff support the service users with swimming sessions, walks and rambling, bus and train trips as well day-to-day activities such as shopping and cooking sessions. Plans to convert the basement flat into an activities centre, accessible to both homes in the group are judged promising. Both service users appear to have a reasonable understanding of the spoken word, simply put, but one member of staff was observed using some sign language to help her communicate with one service user. Records confirm that staff are conversant with individualised behaviour management techniques. There are open visiting arrangements. All staff carry mobile phones and there is a phone on the ground and first floors. One service user does not know how to use a phone but the other is supported to make calls to his family (subject to restrictions requested by the family) and family visits are supported. Dietary needs and preferences are identified as part of the care planning process, and confirmed by day-to-day consultation. Neither service user requires a special diet but their needs and preferences are being catered for. As one member of staff put it – there is a balance between healthy eating and treats. One service user’s weight gain is being monitored and weight charts indicate this is being managed effectively. The dining facilities are not ideal. They comprise plastic garden furniture (because of one service user’s propensity for damaging his environment) Homeville DS0000023224.V345823.R01.S.doc Version 5.2 Page 14 within the kitchen. The area shows signs of wear and water damage, though it is accepted that it is undergoing refurbishment. The service users were joined for lunch, which was judged well prepared and presented. The pace of the meal was unhurried and staff support was judged sensitive and supportive. Homeville DS0000023224.V345823.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 – 21 (Adults 18-65) and Standards 8 – 11 (Older People) are: 18. 19. 20. Service users receive personal support in the way they prefer and require. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users’ physical and emotional health needs are met. Service users’ health care needs are fully met. (OP NMS 8) 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. Service users, where appropriate, are responsible for their own medication and are protected by the home’s policies and procedures for dealing with medicines. (OP NMS 9) The ageing, illness and death of a service user are handled with respect and as the individual would wish. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. (OP NMS 11) 21. The Commission considers Standards 18, 19 and 20 (Adults 18-65) and Standards 8, 9 and 10 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome are is good This judgement has been made using available evidence including a visit to this service. 18, 19, 20 Service users’ health and personal care are based on their individual needs. The principles of respect, dignity and privacy are put into practice. EVIDENCE: The care planning process assesses the extent to which each service user can manage their own personal care, and their choice and control is actively promoted by staff. Daily records are maintained. Homeville DS0000023224.V345823.R01.S.doc Version 5.2 Page 16 The bedrooms are single occupancy to offer privacy though neither service user is risk assessed as able to manage a door key. Observed practice was judged appropriately familiar and respectful. There are enough toilet and personal care facilities (baths, showers, wash hand basins) to enable the service users to exercise some choice, – and staff are available on a 24 hour basis to assist them. There was good anecdotal information about how one service user’s occasional incontinence had been successfully managed. The care planning process routinely addresses a range of standard healthcare needs e.g. GP, optician, chiropodist. The home also accesses care managers, community nurses and specialists (e.g. in behaviour management interventions) as appropriate. The home uses the monitored dosage system (MDS) and medication administration record (MAR) sheets. Recording standards were judged satisfactory, although the question of allergies needs to be more routinely recorded in each case. The manager said that the home has a copy of the Royal Pharmaceutical Society Guidance to ensure its practice is compliant with best practice, though its copy of The British national Formulary was dated 2003 and therefore in need of updating. The home keeps its medication properly secured in a lockable wall-mounted cabinet, and certificates confirm four staff have had medication training over the last 2-3 years, with more training in prospect over the year ahead. The last inspection recommended that the home’s policy on monitoring and addressing the ageing needs of the service users be developed, and the manager was able to demonstrate that this had been addressed. Homeville DS0000023224.V345823.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22-23 (Adults 18-65) and Standards 16-18 & 35 (Older People) are: 22. 23. Service users feel their views are listened to and acted on. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted on. (OP NMS 16) Service users’ are protected from abuse, neglect and self-harm. Service users legal rights are protected. (OP NMS 17) Also Service users are protected from abuse. (OP NMS 18) Also Service users financial interests are safeguarded. (OP NMS 35) The Commission considers Standards 22-23 (Adults 18-65) and Standards 16-18 and 35 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome are is adequate This judgement has been made using available evidence including a visit to this service. 22, 23 People who use the service are supported to express their concerns. There is a complaints procedure in place but it is not being used. Service users are generally well protected from abuse, and have their rights protected. EVIDENCE: The home has a complaints procedure, as required. However, the absence of registered complaints is not judged a realistic reflection of communal living, particularly where outbursts are commonplace. The challenge for this home will, therefore, be to interpret expressions of dissatisfaction into recordable events, so that anyone authorised to inspect the records can properly judge compliance with this standard. It is accepted that staff have been given guidance on interpreting behaviours, and records confirm staff training in managing challenging behaviour. Homeville DS0000023224.V345823.R01.S.doc Version 5.2 Page 18 There was no evidence of independent advocacy being used to support either service user. Service users’ financial transactions are being carefully recorded, supported by receipts; and balance figures are in each case cross-checked by a second member of staff, as evidence of probity. A spot check on one balancing figure was found to match the sum in safekeeping accurately. Less clear, however, was the company’s policy on carrying out periodic audits of its accounts. In discussions, staff confirmed their commitment to challenge and report any instances of adult abuse, though they each went on to say that this had not been warranted in this home. Homeville DS0000023224.V345823.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 (Adults 18-65) and Standards 19-26 (Older People) are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users live in a safe, well-maintained environment (OP NMS 19) Also Service users live in safe, comfortable surroundings. (OP NMS 25) Service users’ bedrooms suit their needs and lifestyles. Service users own rooms suit their needs. (OP NMS 23) Service users’ bedrooms promote their independence. Service users live in safe, comfortable bedrooms with their own possessions around them. (OP NMS 24) Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Service users have sufficient and suitable lavatories and washing facilities. (OP NMS 21) Shared spaces complement and supplement service users’ individual rooms. Service users have access to safe and comfortable indoor and outdoor communal facilities. (OP NMS 20) Service users have the specialist equipment they require to maximise their independence. Service users have the specialist equipment they require to maximise their independence. (OP NMS 22) The home is clean and hygienic. The home is clean, pleasant and hygienic. (OP NMS 26) The Commission considers Standards 24 and 30 (Adults 18-65) and Standards 19 and 26 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome are is adequate This judgement has been made using available evidence including a visit to this service. 24, 25, 26, 27, 28, 29, 30 Service users benefit from living in a with a reasonably safe, and comfortable environment – though matters are raised for attention in respect of its maintenance. The physical design and layout of the home encourages some freedom of movement and independence, but it is not ideal. Homeville DS0000023224.V345823.R01.S.doc Version 5.2 Page 20 EVIDENCE: This home is judged generally adequate for its registered purpose, but some aspects of its layout are problematic in terms of access (see below for details). All areas of the home were inspected and found to be homely and comfortable. And the level of cleanliness is judged satisfactory. The furniture tends to be domestic in style and there were homely touches throughout. There is a small city-style garden at the rear, enclosed by low walls, fencing panels and planting on all sides and paved over to create a patio area. Once cleared of redundant bed furniture and refurbishment materials, this could provide a reasonably pleasant and congenial area to walk about it or sit in. The prospect of a raised sensory garden in one section could make this facility even more attractive. However, it can only be accessed through the basement flat which, in turn, requires leaving the home by the front door and accessing its own front door from steps down from the pavement. This is far from ideal. The home and site have a “No Smoking” policy. One bedroom has an adjoining seating area but the communal areas are, otherwise, on the ground floor. There is a spacious formal lounge at the front of the home and there is a kitchen / dining area, for everyday use. All the chairs tend to uniform in style – this is judged generally suitable, though the use of plastic garden furniture as dining furniture detracts from the homeliness of this property. The kitchen is light, airy, and clean but in need of complete refurbishment. There are WC facilities on both floors, and a choice of bath and shower facilities - all of which are reasonably accessible to bedrooms and communal areas; and these are all properly scheduled for refurbishment. All three bedrooms are spacious and single occupancy. All the bedrooms were inspected and found to be well maintained. In terms of their furniture and fittings, however, they were not fully compliant with the provisions of the National Minimum Standards. Non-provision needs to be justified by properly documented risk assessment or consultation. A number of matters were raised for attention, though it is accepted that most are already within the home’s refurbishment plans. These were reported back to the manager separately. The eventual siting of laundry facilities (top floor, or basement) has been subject to conflicting assessments which will require resolution. Homeville DS0000023224.V345823.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 (Adults 18-65) and Standards 27 – 30 & 36 (Older People) are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users are supported by competent and qualified staff. Service users are in safe hands at all times. (OP NMS 28) Service users are supported by an effective staff team. Service users needs are met by the numbers and skill mix of staff. (OP NMS 27) Service users are supported and protected by the home’s recruitment policy and practices. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users’ individual and joint needs are met by appropriately trained staff. Staff are trained and competent to do their jobs. (OP NMS 30) Service users benefit from well supported and supervised staff. Staff are appropriately supervised. (OP NMS 36) The Commission considers Standards 32, 34 and 35 (Adults 18-65) and Standards 27, 28, 29 and 30 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome are is adequate This judgement has been made using available evidence including a visit to this service. 32, 33, 34, 35 Service users generally benefit from being cared for by a staff team which has the training, skills and numbers to support them and enables them to maintain the smooth running of the service. The safety of service users may be compromised because of the home’s poor recruitment check procedures. EVIDENCE: Homeville DS0000023224.V345823.R01.S.doc Version 5.2 Page 22 The waking / working day has been interpreted as 7am till 9.30pm, and visitors should expect to find two support workers and their line manager on duty. At night there is invariably one member of staff, sleeping but on call. There are wider on-call arrangements to keep people safe. This arrangement was in fact confirmed by this unannounced site visit, and by staff and the staffing rotas seen. There are no dedicated ancillary staff (e.g. cooks or cleaners). These tasks are covered by the staff responsible for direct care, and a white board in the lounge identifies the tasks to be undertaken on each shift. Anyone authorised to inspect the records can readily evaluate their scope for direct care. Both service users are supported to carry out some domestic chores. The previous inspection found this staffing arrangement was in need of attention because of the levels of overtime and sickness, annual leave etc. Since then, back-up staff have been introduced as a direct result. All the home’s personnel files were assessed for compliance against the National Minimum Standards, and were found to be systematically arranged. However, there were some gaps in the records (e.g. interview records, incomplete or no record of induction). Shortcomings in some important recruitment checks (also raised by the last inspection) and recruitment decisions were, however, judged sufficiently serious to warrant follow up and further risk assessment. These matters have been taken up with the manager separately. Staff confirmed having had a range of mandatory training opportunities, such as food safety, fire safety, manual handling, First Aid, and challenging behaviour – as well as some specialist input to meet the service users’ special needs. However, the last inspection found that training investments had not been routinely topped up to ensure practice keeps pace with best practice standards and does not become variable. Records show that this had to some extent been addressed by training booked for the year ahead. Records confirm that all staff are issued with copies of the General Social Care Council Code of Practice. All four support staff spoken to on this occasion confirmed that they had formal supervision from their line manager, which in some cases exceeds the National Minimum Standards, and the manager was said to be accessible and supportive. Less clear, however, was evidence of performance appraisals – which will require attention. Homeville DS0000023224.V345823.R01.S.doc Version 5.2 Page 23 Homeville DS0000023224.V345823.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 (Adults 18-65) and Standards 31-34, 37 & 38 (Older People) are: 37. Service users benefit from a well run home. Service users live in a home which is run and managed by a person who is fit to be in charge of good character and able to discharge his or her responsibilities fully. (OP NMS 31) Service users benefit from the ethos, leadership and management approach of the home. Service users benefit from the ethos, leadership and management approach of the home. (OP NMS 32) Service users are confident their views underpin all self-monitoring, review and development by the home. The home is run in the best interests of service users. (OP NMS 33) 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 homes record keeping, policies and procedures. (OP NMS 37) Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping policies and procedures. (OP NMS 37) The health, safety and welfare of service users are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (OP NMS 38) Service users benefit from competent and accountable management of the service. Service users are safeguarded by the accounting and financial procedures of the home. (OP NMS 34) 38. 39. 40. 41. 42. 43. The Commission considers Standards 37, 39 and 42 (Adults 18-65) and Standards 31, 33, 35 and 38 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome are is adequate This judgement has been made using available evidence including a visit to this service. 37, 38, 39, 40, 41, 42, 43 Homeville DS0000023224.V345823.R01.S.doc Version 5.2 Page 25 The registered manager has the skills required for the role of manager but the business is still being compromised by shortfalls in overall management. The quality of service provided is being assessed and monitored. The health & safety and welfare of both staff and service users are not ensured by current procedures. EVIDENCE: The Commission’s own registration processes have established that the manager has a range of relevant qualifications plus several years experience working with this client group and her registration was confirmed in February 2006. This is a home, which has been able to demonstrate good evidence of its inclusive approach to its service users. Both service users have been clearly benefiting from access to a range of fulfilling activities as well as to mainstream community resources not immediately identifiable with or confined to their special needs. The home has its own Quality Assurance process but findings from the latest questionnaire were not yet available for assessment. The Commission also relies on its own questionnaires for use with service users, referring agencies, care managers and relatives. Feedback comments have been reassuring. There was no evidence of a business development plans or statement of audited accounts. These are required. The views of all stakeholders should be central to these processes, to properly measure the home’s success in meeting its aims, objectives and statement of purpose. The home also needs to embrace its complaints procedure as another useful quality assurance tool and as a means to evidence its ability to resolve dissatisfaction effectively. There was no evidence on site of the proprietors’ regulatory duty to carry out their own inspection visits at least monthly. Breach of this duty is an offence and must be addressed as a priority. This matter has been raised by the Commission before. Homeville DS0000023224.V345823.R01.S.doc Version 5.2 Page 26 Property maintenance records were judged in good order and maintained in the best interests of the service users. The home has the required public liability insurance cover. Weekly petty cash accounts and financial records are judged fully accountable and properly supported by receipts. Homeville DS0000023224.V345823.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 X 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 2 27 2 28 2 29 N/A 30 3 STAFFING Standard No Score 31 X 32 2 33 3 34 1 35 2 36 3 CONDUCT AND MANAGEMENT Standard No Score 37 3 38 3 39 2 40 X 41 2 42 2 43 2 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Homeville Score 3 3 3 3 DS0000023224.V345823.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 4& Schedule 1 Requirement The registered person must ensure the revised Statement of Purpose and Service User Guide is fully compliant with the National Minimum Standard and regulations. Copies must be submitted to the Commission for assessment and future reference 2 YA24 13,23 The building maintenance programme needs to be updated to reflect the current situation and ensure work is completed. Previous requirement – 30/11/06 3 YA39 10,12,15, 24 Action plan to be submitted Regulation 26 visits to be conducted and reports submitted to CSCI as evidence of compliance. Previous requirement: 31/12/05, 31/03/06 31/08/07 31/10/07 Timescale for action 31/10/07 Homeville DS0000023224.V345823.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA7 YA20 Good Practice Recommendations The home needs to demonstrate that it takes more control over the formal care plan reviews. Medication arrangements. The following matters are raised for attention. • The question of allergies should be more routinely recorded on each MAR chart. • The home’s copy of The British National Formulary was in need of updating. Bedroom furniture should be assessed against the provisions of the National Minimum Standard. Nonprovision should be justified in each case by properly documented risk assessments of consultation. Where CRB or POVA First checks have not been unequivocal, properly documented and consulted risk assessments should be undertaken to safeguard recruitment decisions. All staff must complete mandatory training courses. The company should have a business development plan and a policy on carrying out periodic audits of its accounts, to demonstrate probity and viability. The views of all stakeholders will be crucial to the success of this. 3 YA26 4 YA34 5 6 YA35 YA43 Homeville DS0000023224.V345823.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. 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