Inspection on 13/06/05 for ICS 1 Dexter Way

This inspection was carried out on 13th June 2005.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

ICS 1 Dexter Way 22/05/09

ICS 1 Dexter Way 08/06/07

ICS 1 Dexter Way 07/11/05

ICS 1 Dexter Way 22/01/05

ICS 1 Dexter Way 05/08/04

Similar services:

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

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

CARE HOME ADULTS 18-65 ICS 1 DEXTER WAY Off Birchmoor Road Polesworth Warwickshire B78 1AZ Lead Inspector Warren Clarke Announced 13 June 2005 09:30 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 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 Stationary 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. ICS 1 DEXTER WAY E53 S4248 ICS 1 Dexter Way V223277 130605 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service ICS 1 Dexter Way Address Off Birchmoor Road Polesworth Warwickshire B78 1AZ 01827 331713 01527 546888 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Individual Care Services Care Home 5 Category(ies) of Learning Disability registration, with number of places ICS 1 DEXTER WAY E53 S4248 ICS 1 Dexter Way V223277 130605 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 22 January 2005 Brief Description of the Service: 1 Dexter Way is a large domestic-style house situated on the corner of a modern housing estate close to the village of Polesworth. The service is for five adults with a learning disability and each service user has their own bedroom. Two of the bedrooms are situated on the ground floor and have en suite facilities. There is a lounge with a dining area, a kitchen and a small utility room. There are three bedrooms on the first floor, a bathroom and separate toilet. One room upstairs is designated as an office/ sleep in room for staff. Externally at the rear of the house, there is a patio and garden landscaped to meet the needs of the service users. ICS 1 DEXTER WAY E53 S4248 ICS 1 Dexter Way V223277 130605 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was announced and informed by the report of findings of the previous visit, a pre-inspection questionnaire completed by the Home Manager and information from a questionnaire, which service users relatives or friends were requested to complete and to which there was a 50 response. The inspection visit took place between 10.30 AM and 6.50 PM during which time was spent with service users as a group, the premises were assessed, records were examined and the manager was interviewed. On this occasion staff were not formally interviewed, but they were observed in carrying out routine tasks and in how service users related to them. In the section where scores are given to the Home’s performance for the standards against which it was inspected, the reader is advised that the scores reflect overall performance. This therefore does not necessarily mean that all of the quality indicators that flow from the main standard are met. For example, a score of 3 (standard met) might be given, but a requirement might be made to address a single issue related to one of the quality indicators. In the “What they could do better” section of the report below, reference is made to a single requirement yet in the Requirements section there are two. This is because one of the requirements has been made to support the Home Manager in a particular strategy for the health care of a service user and to ensure that if it becomes necessary the strategy will be pursued. This has not influenced the score given and reader should therefore regard this as being supportive of the plan that the Home Manger outlined rather than from the basis of any critical observation. What the service does well: This home provides service users a good material standard of living and takes care to find effective ways to communicate with them so as to establish their personal goals and help them to lead fulfilling lives. It was concluded that this is a very good home, which is providing service users with high standards of care and where staff work well in partnership with other agencies to ensure service users receive the services they require for their health and general well being. In short, service users presented as cheerful, content and, in the inspector’s opinion, are being afforded a good quality of life. ICS 1 DEXTER WAY E53 S4248 ICS 1 Dexter Way V223277 130605 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? 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. ICS 1 DEXTER WAY E53 S4248 ICS 1 Dexter Way V223277 130605 Stage 4.doc Version 1.40 Page 7 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 Standards Statutory Requirements Identified During the Inspection ICS 1 DEXTER WAY E53 S4248 ICS 1 Dexter Way V223277 130605 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 and 3 Those in charge of the Home ably demonstrate that service users’ health and welfare are both promoted and safeguarded by clarity about what their needs are and the Home’s ability to respond to them effectively. EVIDENCE: Records kept at the Home and accounts given by the Home Manager confirmed that service users who become resident are usually already receiving services from statutory agencies such as health and social services. This means that their needs are assessed by all the specialists involved and their findings and recommendations culminate in an overall assessment (i.e., the comprehensive assessment or Care Management Assessment). In one case, which was examined closely, it was noted that prior to admission to the Home, the service user was assessed by a psychologist specially to determine whether the Home would be suitable. Having established that the Home might be suitable, the service user visited the Home on two occasions, which were used as trial visits. There then followed a meeting of all the professionals involved in the service users case to consider the assessments, the observations made of the trial visit and to determine whether the Home is appropriate. This illustrates the rigorous care taken to ensure that there is a clear understanding of each service user’s needs and the ability of the Home to fulfil them. ICS 1 DEXTER WAY E53 S4248 ICS 1 Dexter Way V223277 130605 Stage 4.doc Version 1.40 Page 9 The Home is required to conduct its own assessment where a service user is referred for admission without a Care Management Assessment. This is also to establish both the service user’s needs and whether the Home’s resources are commensurate with them. An assessment format structured to find out the individual’s strengths, needs, wishes and expectations was provided as evidence of the Home being able to fulfil this requirement. This together with evidence of risk assessments, ongoing monitoring and care planning, which is dealt with in the next section of the report, for each service user provides further confirmation of the Home’s successful performance in understanding and responding to services users’ needs and personal aspirations. All the service users have some form of communication difficulties and in some cases this is profound. Nevertheless, staff members were able to show that they use a range of appropriate means of communication such as Makaton to try to ascertain service users wishes, feelings and personal development requirements. In some cases, this might mean building up a vocabulary nonverbal cues of the individual’s reactions to particular ways of caring for them and to people, things and events, as observed during the inspection. ICS 1 DEXTER WAY E53 S4248 ICS 1 Dexter Way V223277 130605 Stage 4.doc Version 1.40 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7 and 9 This Home is providing the service users, who are currently resident, with a good quality of life. That is to say, those in charge of the Home ensure that there is a clear understanding of each service user’s needs arising from their disabilities and health conditions and, as far as possible, try to mitigate the effects so that the individuals can live fulfilling lives. EVIDENCE: Among service users records, which were examined, were documents showing that the staff have translated the needs identified in each individual’s assessment into a plan of action (the Individual Plan). This dictates how the service user’s care is to be provided day-to-day and takes account of their health and personal care routine. In this connection, there was evidence of an agreed strategy for dealing with episodes of fits, medication regimens and instructions about how particular service users’ personal care, such as bathing, should be carried out and which reflected each individual’s preference. ICS 1 DEXTER WAY E53 S4248 ICS 1 Dexter Way V223277 130605 Stage 4.doc Version 1.40 Page 11 The individual plans also demonstrate the need that monitoring and ongoing assessment of each service users disabilities was being recognised. That is, it is recognised that as service users develop and their needs change both their living environment and the manner in which their care is provided have to be adapted to accommodate this. A record described as the Daily Living Goals Sheet was seen to detail what has been established as each service user’s interests, strengths and difficulties. This together with direct observations, accounts given by service users and by the manager confirmed that due regard is being given service users’ personal development and aspirations. For example the Daily Living Goals record shows that each service user has a programme of activities, interests and meaningful day occupation. In one instance, a service user is being supported to enhance skills in daily living by being permitted to make a cup of tea every morning under staff’s supervision. It was noted that though service users’ disabilities limit their ability to make independent decisions they are supported to make known their wishes and feelings in any decisions about their lives and the individual plans are reproduced in a format that they are likely to understand. Furthermore, in comment cards, which were completed by relatives, they indicated that where the particular service users are not able to make decisions, they (the relatives) are consulted about decisions to be made. This provides proof of the Home’s attempts to involve service users and their families in the assessment and care planning process. At the last inspection, a requirement was made for service users’ individual plans to be reviewed every six months. Service users personal records confirm that this is being done and that the Home review process is done in conjunction with that which is conducted by health and social services under the assessment and care management arrangements. Examination of service users’ records, the Homes policies and procedures, discussion with staff and observations of practices during the inspection did not reveal any unwarranted restrictions of rights and choices. For instance, some service users choose to go to bed early and rise early and others opt to stay up later - some prefer to be assisted to bathe at night while others rather this is done in the morning. A risk assessment has been conducted in respect of each service user, which clearly identifies his or her vulnerabilities and capacities and this informs any curtailment of liberty, self-determination and considerations of risks, which might be relevant to the individual’s circumstances. For example, as cited elsewhere, the service user who opts to make his or her own cup of tea in the mornings is allowed to do so, but the assessment of risk for this individual to carry out this task indicates that staff supervision is required. ICS 1 DEXTER WAY E53 S4248 ICS 1 Dexter Way V223277 130605 Stage 4.doc Version 1.40 Page 12 In recognition of service users common vulnerability, the Home is required to have a procedure, which is to be invoked in the event of a service user’s unexplained absence from the Home. Such a procedure was seen at inspection and was deemed appropriate. There were no reports of any unexplained absences since the last inspection. None of the service users are able to manage their own finances independently and the registered provider has submitted a written declaration that the organisation has been granted powers to act for them by the Department of Work and Pensions under the Appointee provisions. Further, that those powers are being exercised in accordance with guidance given by the Commission. That is to say, the service users finances are being administered with due propriety. ICS 1 DEXTER WAY E53 S4248 ICS 1 Dexter Way V223277 130605 Stage 4.doc Version 1.40 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 15 and 17 Effective management of the Home is causing it to be operated so that each service user’s care is planned and delivered in ways that enable their involvement in appropriate and meaningful activities. There are also opportunities for them to be part of the local community and to benefit from its facilities and services. Adequate provisions have been made for service users to have contact with relatives and friends and to meet with others in social and other settings. Having regard to what was seen in the records, observed in practice and gleaned from service users, it is concluded that their health and well being are being properly promoted and that the catering arrangements that the Home makes contributes significantly to this. EVIDENCE: As reported earlier, each service user has a plan – the Daily Living Goal Sheet – detailing the arrangements for their occupation, leisure interests and personal development goals. ICS 1 DEXTER WAY E53 S4248 ICS 1 Dexter Way V223277 130605 Stage 4.doc Version 1.40 Page 14 This together with information, both documentary and that given by service users and staff, confirmed that two service users attend a Day Occupation Centre where they are involved in carrying out tasks in a sheltered setting in keeping with their abilities and interests. These are said to include preparing pots for planting, recycling of waste paper, and arts and crafts. They receive a small financial reward for this, which has the effect of causing the service users to feel that they are making a contribution and are able to participate in ways not dissimilar to their peers who do not have a disability. Above all, service users are reported to be happy to engage in those activities and look forward to meeting with those with whom they have formed attachments and friendships at the Day Occupation Centre. Another two service users whose conditions limit the scope for them to benefit from the type of activities outlined above, were seen to have a programme of activities tailored to their particular needs. Their programme includes involvement in events at a local centre for people with learning disabilities where they engage in activities such as ‘hand over hand painting’. They also benefit from outings to another town, which provides the use of a sensory room. Among the social and leisure events in which service users participate are concerts at the local Assembly Rooms, visits to places of interest and entertainment such as Tamworth Castle and Drayton Manor Park. On the day of inspection a visit was planned to a park with lunch out. This was confirmed by service users as a regular event and from which they were observed to return in cheerful mood. Service users are provided with an annual holiday at a resort and arrangements of which the inspector was apprised have already been made for this year’s event. These events and those outlined above, which are intended to be more therapeutic, provide ample evidence of service users being supported to live full and enjoyable lives. It was established that those in charge of the Home make reasonable efforts to enable service users to become involved in the local community. As explained earlier, they use some local facilities for occupation, leisure and entertainment and also come into contact with members of the local community in the shops, hairdresser salons and other such venues. The manager reported that the Home enjoys good relationships with its neighbours and, that in this regard, service users are involved in conventions such as the exchange of Christmas cards. There are no unreasonable restrictions on service users’ receiving visitors at the Home and the manager described events, which suggest that efforts are made to maintain service users’ family links. The occupation and leisure activities described above, in which service users are involved, were taken as evidence of the opportunities they have to meet people and establish relationships. ICS 1 DEXTER WAY E53 S4248 ICS 1 Dexter Way V223277 130605 Stage 4.doc Version 1.40 Page 15 It was noted that one service user is significantly younger than the others therefore this individual’s need for association with age-related peers should always be taken into account. Catering in the Home is organised on a domestic scale so that though there is no dedicated cook, a member of staff on each shift is nominated to prepare the meal during this period. All staff members have received Food Hygiene training (the Statement of Purpose needs to be updated to reflect this) and meals – four per day at least one of which is hot and includes supper – are prepared subject to a forecast menu, in the planning of which service users are involved. The menus, stores of food seen and food prepared at the time of inspection all indicate that service users are provided with a varied and wholesome diet and reasonable choice of food. A mealtime, which was directly observed, was a relaxed, convivial occasion when service users keenly related the experiences of the day’s activities to each other and to staff. The inspector was satisfied that where service users nutritional needs require assessment and monitoring, this was being done and that the services of specialists had been sought in this regard. The manager cited a case of particular concern in this connection and was advised to pursue the plan of action, which she proposed. ICS 1 DEXTER WAY E53 S4248 ICS 1 Dexter Way V223277 130605 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 and 20 Service users are being maintained in good health relative to their particular conditions. The personal care that they receive, both in respect of their health and disabilities, is provided in a sensitive manner, which gives due regard to their privacy and dignity. The arrangements for service users medication were also deemed to conform to the required standards therefore reducing the likelihood of the wrong medication being given or contrary to what has been directed by the doctor. EVIDENCE: Examination of care plans and accounts given by service users and staff confirm that personal care is being provided on the basis of what the individual wishes and needs. In respect of service users who do not communicate verbally, careful observations are made of their reactions to particular approaches to their personal care so that staff become familiar with what they prefer. For example, three sets of clothing are presented to a particular service user each day and staff have come to know that the first set that the service user touches is what this individual prefers for the occasion. It was noted that all service users require some degree of assistance with their ablutions and some with their toilet. ICS 1 DEXTER WAY E53 S4248 ICS 1 Dexter Way V223277 130605 Stage 4.doc Version 1.40 Page 17 The facilities available such as en suite ensure that those with the higher level of dependency are able to have intimate aspects of their care conducted in private and, as earlier reported, staff establish the routines and approaches that the individual prefers in this context. This is reflected in the service user’s care plan so as to ensure consistency of approach. The Home operates a key worker system and achieves a reasonable ratio between the gender of service users and staff thus demonstrating its ability to provide choice of who conducts certain service users’ intimate care. Documents found among service users’ records show that they are all registered with a GP from whom the manager believes they receive a good service. There was also evidence that where specialist services such as psychiatric and psychological services are required, they have been provided. In short, proper provisions have been made for service users physical and emotional health. These provisions are made both in relation to preventative and curative health care measures. The Home policy and procedure for storing, administering and disposal of service users’ discontinued or unused medication was examined and was deemed to conform to the required standards. All staff members have received training in the safe handling and administration of medication. The pharmacy that supplies the Home’s medication is understood to provide advice and conducts periodic audits in relation to the medication policy. The outcomes of those audits were not checked on this occasion, but the medication records were examined and were found to be accurate and up-todate. Similarly, the provision for storing medication – a wall-mounted secure cabinet in a room that is kept locked – conforms to current standards thus ensuring the level of safety required. ICS 1 DEXTER WAY E53 S4248 ICS 1 Dexter Way V223277 130605 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23 There are more than adequate measures in place for the protection of service users from abuse and for ensuring that any concerns they might have are taken seriously and acted upon. Apart from this, the whole ethos of the Home is one in which the focus is on the service user and in which staff are keen to engender feelings of happiness and contentment. EVIDENCE: The Home has a complaints procedure, which conforms to the requirements of the National Minimum Standards and is reproduced in a form that is appropriate to service users needs. Additionally, there is a specific service user quality monitoring questionnaire, which has been administered and is intended to be used from time to time to elicit, pro-actively, the individual’s views of the quality of care that they receive. These formal processes confirm the Home’s compliance with relevant regulations and standards. However, more importantly the care that staff members take in establishing service users’ needs and how they respond to them in a person-centred way is, perhaps, a more potent indicator of the Home’s receptiveness to the views and any concerns service users might have. A register, which is kept at the Home for recording service users’ concerns and complaints, showed that none were made since the last inspection. Relatives who responded to a questionnaire, which was administered as part of the inspection, indicated that they too have been made aware of the Home’s complaints procedure, but have had no cause to complain. As required, the registered person has developed and introduced a policy to guard against the abuse of service users. ICS 1 DEXTER WAY E53 S4248 ICS 1 Dexter Way V223277 130605 Stage 4.doc Version 1.40 Page 19 The policy, which is aligned to others such as that for whistle blowing, gifts and bequests, and administration of service users’ finances was examined and deemed to be effective for its purpose. It will, however, be necessary for the Home Manager to ensure that the policy is in accord with the Area Adult Protection Procedures and that staff members receive familiarisation training with those procedures to build upon the foundation training, which they have already had in the Protection of Vulnerable Adults. ICS 1 DEXTER WAY E53 S4248 ICS 1 Dexter Way V223277 130605 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25 and 30 Service users’ individual and collective needs and lifestyles are been met in this Home, which provides a warm, safe and homely environment. EVIDENCE: Operated from premises on a modern housing estate, which have been adapted from a conventional family dwelling to its current use, this home is indistinguishable from others in the neighbourhood and therefore service users are unlikely to feel conspicuous. The home is close to the village centre and the usual amenities such as shops, pubs, hairdressers, etc. Maintained in very good structural and decorative order, the Home offers single bedroom occupancy. Although they were not measured, the Registered Provider, in the Statement of Purpose, has shown that the size of bedrooms and communal areas (sitting and dining space), in aggregate, comply with the required standards. Visually this also seems the case, as all the rooms were spacious and pleasingly furnished and fitted with items of good quality, which are domestic in design and scale. Bathrooms and toilets are provided in excess of the required ratio for the number of service users: there being three bathrooms (two of which are en suite) for five service users. ICS 1 DEXTER WAY E53 S4248 ICS 1 Dexter Way V223277 130605 Stage 4.doc Version 1.40 Page 21 In addition, there are two separate toilets, one on each of the two floors. The numbers and location of these facilities mean that they are easily accessible to service users wherever they are within the Home. Being maintained in clean condition throughout, the home was found to be free of offensive odours, adequately lit and ventilated. The home has its own transport, which is adapted for wheelchair users thus service users’ access to local amenities and other facilities is not a problem. The adaptations which have been made to the Home also means that service users have access to all areas registered for their use, regardless of their disability. This includes the rear garden, which is equipped and maintained in excellent condition, providing a pleasing and useful facility. Satisfactory provisions have been made for the premises to be kept clean and hygienic. There is a utility room sited such that laundry does not have to be taken through the kitchen or the living/dining areas and hand washing and drying facilities are provided in all areas where these are necessary for the maintenance of hygiene. In essence, the material condition of the home is very good and there is requisite attention to detail in cleanliness and hygiene as one of the means of promoting and safeguarding the health of both service users and staff. The opening on one of the first floor bedrooms was checked and found not to be fitted with a restrictive safety device. In the interest of safety it will be necessary to fit such a device to all service users’ bedrooms on the upper floor as a precaution against the event of a service user attempting to exit the room via this route. Serious accidents have been known to occur as a result of such an event in other establishments. ICS 1 DEXTER WAY E53 S4248 ICS 1 Dexter Way V223277 130605 Stage 4.doc Version 1.40 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 34 and 35 Safeguards in the Home’s staff recruitment and selection practices are adequate for the protection of service users. Further, their individual and collective needs are also being satisfied by a staff team, which is balanced in terms of training, qualifications and experience. EVIDENCE: A sample of three staff members’ records were examined and revealed that they were required to provide sufficient details about themselves, their work history and their relevant experience for the post. This was considered to enable a reasonable judgement of their suitability. Additionally, there was evidence of checks being made of staff character and to establish whether they have committed any past professional misdemeanours or have any criminal records as would render them unsafe to work with vulnerable adults. It was also established that staff are required to serve a probationary period before their position is confirmed on a permanent basis; that they are provided with the terms and conditions of their employment and that the Codes of Practice and Conduct of the General Social Care Council have been adopted by the Home and staff are aware of this. ICS 1 DEXTER WAY E53 S4248 ICS 1 Dexter Way V223277 130605 Stage 4.doc Version 1.40 Page 23 Examination of records related to staff training showed that the Registered Person has an established staff induction programme designed to provide newly recruited staff with a satisfactory working knowledge of the wider organisation and the Home’s place within it. The programme also equips staff with an understanding of the Home’s Statement of Purpose and the basic working practices that they need to fulfil it. The staff induction programme is allied to the foundation training requirements specified by the Sector Skills Council, which means that staff members have to be provided with training in how to meet the needs of this particular service user group and to be able to do so with equity and safety. In this regard, 57 of staff have achieved National Vocational Qualification (NVQ) at level 2 and two are currently working towards level 3 in care. It was noted that staff members have received training in all, and in the case of the two most recently appointed in some, of the following:- First Aid, Food Hygiene, Lifting and Handling, Fire Safety, safe administration of medication. These areas of training ensure that staff members conduct service users’ care with safety. Among other areas of training which include working with persons with autism, the care of those with epilepsy, Managing Challenging Behaviour, Disability Awareness and Coping with Bereavement equip staff to care for service users with precision and in an anti-discriminatory way. In ensuring that staff development and training compliments the effective running of the Home and have the desired impact on service users’ care, it was noted that each staff member has a training and development profile. Further in demonstrating its capacity to use staff training to respond to service users’ specific needs, the registered person arranged Coping with Bereavement training so that staff could help service users with their grief at the death of one of their fellows. The Home’s very good performance is this area is captured in the feedback in a Relatives/Visitors Comment Card, which states: “I have no [other] comment to make about the staff, as they are first class”. ICS 1 DEXTER WAY E53 S4248 ICS 1 Dexter Way V223277 130605 Stage 4.doc Version 1.40 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 39 and 42 Service users are benefiting from this Home, which is effectively managed, open and progressive in its development, and which takes all reasonable action to promote and safeguard their health, safety and welfare. EVIDENCE: The current manager, who is not yet registered but has applied to become so, previously held the position of deputy manager of the Home for several years. The post holder therefore has the necessary management and supervisory experience to be able manage the Home such as to ensure the proper care of service users. The manager’s duties are made clear in the job description for the post and they are in accordance with the requirements of standard 37.3, which summarises a registered manager’s statutory responsibilities in relation to the proper running of the Home. ICS 1 DEXTER WAY E53 S4248 ICS 1 Dexter Way V223277 130605 Stage 4.doc Version 1.40 Page 25 Evidence provided by the manager in the form of a staff training profile, shows that the post holder is undertaking a course leading to NVQ level 4 in management and care and continues to receive in-service training with the intention of updating knowledge, skills and competence in managing the Home. This confirms that the Registered Person, in the circumstances, has acted to ensure that the Home is being run in accordance with its stated purpose. The score given for performance against this standard is intended to reflect overall achievements, but also take account of the manager not yet being qualified or registered. A quality assurance system has been introduced in which staff use a questionnaire specifically designed to elicit in a deliberate way, service users’ views about their care and the running of the Home. This is in addition to the staff’s routine endeavours to listen to service users and be attuned to the cues they give in response to day-to-day care activities. It was also noted that a stakeholder survey has been conducted, which included relatives, GPs, Hairdresser, Psychologist and others who have contact with the Home and the service users. The results of these surveys have not yet been analysed but, when they are, the manager should use them to inform the review of the quality of care dictated by regulation 24 and must publish the results and make them available to service users, the Commission and other relevant parties. This evidence is indicative of the Home’s efforts to engage service users and their representatives positively in influencing the standards of its service and in its development. In considering the Home’s performance in relation to the measures taken to promote and safeguard service users health, safety and welfare, assessment was made of the arrangements made for first aid, transferring service users with mobility difficulties, food and general hygiene, accident prevention, security of the premises, etc. It was found that 75 of the staff team have received training in fist aid and arrangements have been made for the others to be so trained in the near future. This means that on every shift there is at least one member of staff capable of administering fist aid. All staff members have had training in lifting and handling thus the registered person has demonstrated that due care has been taken to ensure that the transferring of service users with mobility difficulties can be performed safely. As there is no dedicated cook, staff take turns to prepare meals and the records showed that they have all received training in food hygiene. Risk assessments were produced at inspection, which showed that consideration has been given to the potential hazards in the Home’s environment and, where indicated, control measures have been introduced to eliminate or reduce risks. Those risk assessments include accident prevention such as trips and falls, risk of scalding from hot water, access to and inappropriate use of cleaning materials, etc. ICS 1 DEXTER WAY E53 S4248 ICS 1 Dexter Way V223277 130605 Stage 4.doc Version 1.40 Page 26 Particular attention is also paid to fire safety and the reduction or elimination of danger from use of gas and electrical appliances. In this regard, records were provided to show that gas and electrical appliances (including portable equipment) are tested at the required frequency. Furthermore, all the necessary fire precaution measures – fire alarm system, heat and smoke detection systems, emergency lighting and fire fighting equipment - have been taken. It was also noted that those systems are routinely serviced by specialists and that actions that the registered person needs to take such as arranging for staff to receive instruction in fire safety, conducting fire drills and weekly tests of the fire alarm systems were being carried out and are documented. ICS 1 DEXTER WAY E53 S4248 ICS 1 Dexter Way V223277 130605 Stage 4.doc Version 1.40 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 3 x x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 x x x x 3 Standard No 11 12 13 14 15 16 17 x 2 3 x 3 x 3 Standard No 31 32 33 34 35 36 Score x x x 3 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 ICS 1 DEXTER WAY Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 2 x 3 x x 3 x E53 S4248 ICS 1 Dexter Way V223277 130605 Stage 4.doc Version 1.40 Page 28 No 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 17 Regulation 13 Requirement Proceed, as discussed at inspection, with advocating for one of the service users to receive elective treatment for an eating disorder unless such treatment has already been agreed. Restrictors must be fitted to the service users bedrooms on the first floor as a precaution against any occupants attempting to climb out and injuring themselves. Timescale for action As necessary 2. 24 13 07/10/05 3. 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. Refer to Standard 23 Good Practice Recommendations The Home Manager should obtain a copy of the Local Area Adult Protection Procedures, ensure that staff members are familiar with them and the Homes own procedure are in accord with them. The data from the service users questionnaire and the stakeholders survey should be analysed, the results should be used to inform the review of the quality of care E53 S4248 ICS 1 Dexter Way V223277 130605 Stage 4.doc Version 1.40 Page 29 2. 39 ICS 1 DEXTER WAY 3. 15 and it should be published. A copy must be made available to the service users, the Commission and to other relevant parties. It is advised that when the youngest service user is well enough arrangements should be made for this individual to have more contact with other young people. ICS 1 DEXTER WAY E53 S4248 ICS 1 Dexter Way V223277 130605 Stage 4.doc Version 1.40 Page 30 Commission for Social Care Inspection Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI ICS 1 DEXTER WAY E53 S4248 ICS 1 Dexter Way V223277 130605 Stage 4.doc Version 1.40 Page 31 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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