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Inspection on 20/01/06 for ICS 60 Ward Grove

Also see our care home review for ICS 60 Ward Grove for more information

This inspection was carried out on 20th January 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

At the last inspection the Home was assessed as providing: "a very comfortable environment for service users, which both in appearance and how service users respond gives a homelike impression. Staff members work well with service users` relatives and with other agencies, such as Day Occupation Centres and the health services, to ensure that there is a co-ordinated approach to service users care. Although all service users at the home have communication difficulties, much effort is made to ensure that there is an understanding of how they prefer their care to be given, that they are afforded choice and that their rights as adults are respected. In short, a well run Home in which service users appeared completely at ease; where due regard is given to their individuality and proper emphasis placed on preserving their privacy and dignity". Nothing has changed significantly to alter this assessment, but as the requirements and recommendations show, there a few practice and procedural matters that need to be addressed.

What has improved since the last inspection?

There was only one requirement at the last inspection, i.e., for the repair of a broken drawer in a piece of furniture in one of the service users` bedroom and this has been fulfilled. The most significant improvement, however, is the restructuring of the individual plan. This is a document that sets out each service users needs and personal aspirations and how the Home will act to meet them. These plans are regarded, as an improvement because they reflect a sound understanding of the service users` needs and set clear, realistic and measurable objectives for meeting them. Further, in being pictorially illustrated, they show that a real attempt has been made to make them accessible to service users in terms of their understanding of their contents.

What the care home could do better:

Some thought needs to be given to how staff are deployed so as to ensure that there is at all times a sufficient number of staff on duty, as all the service users are highly dependent. It is also considered that because of service users high dependency, where only one member of staff is rostered for duty (the exception rather than the rule) this has adverse implications for safe caring and choice. In the interests of safety and in keeping with the Registered providers own medication procedures, it will be necessary for all medicines to be kept in the medicine cupboard.

CARE HOME ADULTS 18-65 Ics - Ward Grove, 60 60 Ward Grove Warwick Warwickshire CV34 6QL Lead Inspector Warren Clarke Unannounced Inspection 20th January 2006 09:30 Ics - Ward Grove, 60 DS0000004365.V280090.R02.S.doc Version 5.1 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 Ics - Ward Grove, 60 DS0000004365.V280090.R02.S.doc Version 5.1 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. Ics - Ward Grove, 60 DS0000004365.V280090.R02.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Ics - Ward Grove, 60 Address 60 Ward Grove Warwick Warwickshire CV34 6QL 01527 546000 01527 546888 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) Individual Care Services Miss Emma L Benton Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Ics - Ward Grove, 60 DS0000004365.V280090.R02.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The Manager to successfully complete the Registered Managers Award by 31 August 2006. Certificate for Registered Managers Award to be seen by CSCI when available and copies to be taken for file. 23rd August 2005 Date of last inspection Brief Description of the Service: 60 Ward Grove is a registered care home for three younger adults (18 - 65) with a learning disability. The three service users also have physical disabilities and the home has been fully adapted to meet their needs. The home, a bungalow, is situated in a small cul-de-sac in Myton, which is on the outskirts of the town of Warwick. The home has its own transport, which is necessary as local amenities and facilities are not within easy walking distance. All facilities in the home are on the ground floor. The shared space consists of a lounge with dining area, kitchen and bathroom. There are four bedrooms, one is used as the sleepin/office for staff. The detached garage has been adapted to house the laundry facilities. There is a well-maintained garden at the rear of the property, which is easily accessible to service users. The home is considered to be a home for life for current service users, unless the home can no longer meet service users’ needs, or they express a wish to move. Ics - Ward Grove, 60 DS0000004365.V280090.R02.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the second inspection of the Home during this inspection year thus follows up on that which was conducted during the summertime and takes account of the findings on that occasion. As this inspection was unannounced, we did not administer questionnaire to service users or others and the Manager was not present. However, as usual, care activities, including the preparation and consumption of a meal, were observed during the inspections and the inspector was able to watch how service users were assisted to spend their leisure on return from their day occupation. In the process, staff members on duty were interviewed relevant records were examined and the condition of the premises was assessed. Note 60 Ward Grove, the name of the establishment, which was inspected, is referred to as the Home throughout the report. Where reference is made to the standards this means the National Minimum Standards for Care Homes for Adults (18 – 65) and where the regulations are mentioned this relates to The Care Homes Regulations 2001. What the service does well: What has improved since the last inspection? There was only one requirement at the last inspection, i.e., for the repair of a broken drawer in a piece of furniture in one of the service users’ bedroom and this has been fulfilled. The most significant improvement, however, is the restructuring of the individual plan. Ics - Ward Grove, 60 DS0000004365.V280090.R02.S.doc Version 5.1 Page 6 This is a document that sets out each service users needs and personal aspirations and how the Home will act to meet them. These plans are regarded, as an improvement because they reflect a sound understanding of the service users’ needs and set clear, realistic and measurable objectives for meeting them. Further, in being pictorially illustrated, they show that a real attempt has been made to make them accessible to service users in terms of their understanding of their contents. 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 - Ward Grove, 60 DS0000004365.V280090.R02.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Ics - Ward Grove, 60 DS0000004365.V280090.R02.S.doc Version 5.1 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 the following standard(s): 2 The care service users receive is underpinned by comprehensive assessment of their needs. This enables sound planning to ensure that there are effective interventions in relation to their health and physical care requirements and that they are supported to achieve their personal goals, which are likely to result in fulfilment or a good quality of life. EVIDENCE: At the last inspection it was recognised that the original Care Management assessments, which informed service users admission to the Home some ten years ago, were outdated. It was, however, also noted that there was evidence of ongoing needs assessment of each service user, which takes account of all the areas specified in standard 2.3, e.g., suitability of the accommodation, health and personal support and specific disability needs. Since then, an assessment and care planning system, which was being developed at the time of the last inspection has been introduced. The new assessment format also addressed service users’ needs holistically and is presented in a style, which makes it easy to be assimilated by staff. For example, if anyone needed to acquire a speedy understanding of a particular service users health and personal care needs this is set out in a discrete section of the documentation and is in a form capable of being easily updated so that the information is always current. Ics - Ward Grove, 60 DS0000004365.V280090.R02.S.doc Version 5.1 Page 9 Of particular note is that the individual assessments of service users at the Home not only make clear their inescapable and basic needs, they also give due regard to the individual’s strengths and difficulties, and the indicative ways that these might be enhanced or remedied. This was seen in the way that staff encouraged the service users who have difficulty with conventional means of communication to be included and engaged using their particular mode of so doing. Further, though service users degree of learning disabilities prevent them from directly contributing to the assessment process, efforts are made to reflect what is understood of their wishes and feelings, as derived from observations of them, in the process. In respect of service users health and disabilities, there was information appended to the assessment document clearly showing that needs in these areas have been assessed by relevantly qualified specialists. This ensures that any care or support that staff members are required to give in this regard is informed, precise and safe guidance. A discrete aspect of the assessment of each service user is an assessment of risk intended to ensure that as far as possible, they are protected from harm both within and outside the Home. Ics - Ward Grove, 60 DS0000004365.V280090.R02.S.doc Version 5.1 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 the following standard(s): 6 Those responsible for the Home have demonstrated that they not only give careful consideration to finding out what each service user’s needs are, but that in developing a care strategy or individual plan for each person, no crucial aspect of their care is left to chance. Further, service users benefit from the Home’s inclusive care approach and a regime that promotes normalisation within reasonable parameters of risk taking. EVIDENCE: As is the case with the assessment of service users, in the previous section, the Home Manager has introduced a new format for setting out each service users care action plan or individual plan. The new plans are based on the assumptions that service users are to be resident at the Home on a permanent basis, and against all their assessed needs in the areas specified in standard 2.3 are set out the actions which are to be taken to meet those needs. Accordingly, each individual plan shows what the service user’s needs are in regard to, say, health and personal care, purposeful occupation/education, cultural and spiritual needs and what the Home is to do to meet those needs. Ics - Ward Grove, 60 DS0000004365.V280090.R02.S.doc Version 5.1 Page 11 Taking as an example service users health and personal care, there is a clear unique regimen for each of them specifying how their particular condition is being managed, what monitoring needs to be done in this regard and the specialist involved and how to engage their support when needed. This approach is applied to all other aspect of the service user’s care requirements and what is known of their aspirations. Moreover, from information recorded in service users’ daily notes and observations at inspection, it was seen to be working in practice. What is to be achieved for each service user in relation to assessed needs and the actions, which are agreed as necessary to meet those needs and the desired outcomes were seen to be set out in precise terms. It was therefore possible to track through from the individual plans to the daily notes, which record what staff members do or how they are caring for service users on a day-to-day basis (inputs) in order to gauge whether they were fulfilling each person’s care needs requirements. The inspector’s assessment is that the individual plans are commendable for their clarity and the Home is using them effectively to ensure that service users receive the precise care that their circumstances and assessed needs dictate. In all instances the individual plans give a clear account of service users’ specialist requirements in relation to the health and disabilities and the nature of interventions of the specialist services involved. For example, it was noted that service users’ were receiving inputs from epilepsy specialists, physiotherapists and occupational therapists and dietician. This confirmed that needs outlined in their individual plans in relation to their health and disabilities are being addressed. It was noted that service users’ individual plans included a statement recognising that their significant learning disabilities limit the extent of their contribution to the plan. However, staff members have come to understand each service user’s personality, interests, likes and dislikes and indicated that these have been taken into account. For, instance in planning leisure activities for a particular service user, this person’s interest in music forms part of his leisure activity programme. Staff members have also illustrated the individual plans to aid service users’ understanding of them. What the plans do not show is any evidence of service users’ family or advocate’s involvement in drawing them up. With this in mind, it is recommended that since it is agreed that service users’ learning disabilities limit their full involvement in their individual plan and their understanding of it, their family or advocates or Care Manager/Social Worker should be requested to comment upon and, as appropriate, endorse the plan. Ics - Ward Grove, 60 DS0000004365.V280090.R02.S.doc Version 5.1 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 and 17 Service users in the Home profit from the effective consideration given and actions taken to ensure they have a lifestyle that is likely to promote their general well being, compensate for limitations caused by their disabilities and which might contribute to their personal fulfilment. EVIDENCE: At the time of inspection two of the three service users were regularly attending a day resource centre, where they are able to meet with others of similar age and circumstances. This provides a social outlet for those service users and the opportunity to establish friendships with others outside the Home. The Centre also provides services such as physiotherapy and occupational therapy which means that service users are able to receive, in this setting, some of the specialist monitoring and care that they need. Documentation at the Home including service users’ records show that the Centre provides them with meaningful occupation: arts, crafts and music, some of which takes place at a local college of further education thus further extending the range of venues and opportunities that service users are provided for social contact and interaction. Ics - Ward Grove, 60 DS0000004365.V280090.R02.S.doc Version 5.1 Page 13 It was noted that a service user who prefers not to join in the more structured occupation arrangements as offered by the Day Centre, is provided with a more flexible and individual programme of activities. This includes visiting places of interest, going to the cinema, accompanying staff on shopping trips for the Home and for personal requisites. An assessment was made of the extent to which service users are enabled to be part of the local community and from records seen and staff’s account it was concluded that they are indeed supported in this regard. That is, they use local facilities such as pubs, restaurant and shops. Those who wish to practise their religion are enabled to attend local relevant places of worship and one service user is visited by an official of that individual’s church. Staff said that the Home enjoys good relations with its neighbours and this is reflected in usual conventions such as exchanging Christmas cards and neighbours joining service users at the Home for social events such as barbecues. At the last inspection service users’ relatives in response to a questionnaire, which was administered as part of the inspection indicated concern that during a period when there was some staff shortage this limited the scope for social and leisure activities outside the Home. This issue was largely resolved at the time of that inspection and the Registered Person was advised to inform relatives accordingly. A staff member on duty at the time of this inspection said that relatives have been informed of the resolution of the staff shortage and the then current situation of service users’ social and leisure activities with which they are now satisfied. The range of social and leisure activities available to service users now includes walks in the park (there is a park of noted local interest nearby), visits to the cinema and other venues of entertainment, bowling, etc. In explaining how service users were supported to celebrate Christmas, staff said that arrangements were made for service users to see a performance of a ballet; they went to a pantomime and joined service users from other homes for a party. With this in mind the inspector was satisfied that service users are being provided sufficient opportunities to benefit from a wide range of social and leisure pursuits. As outlined above service users are enabled to have contact with others outside the Home and to establish and maintain friendships. The Home has reasonable visiting arrangements and active encouragement is given to both service users and their families to maintain contact. At the time of inspection all service users were having contact with their families by visits and telephone calls. This means that service users are not isolated and are able to retain their sense of belonging. Ics - Ward Grove, 60 DS0000004365.V280090.R02.S.doc Version 5.1 Page 14 Within the outcome measures related to service users’ health, lifestyle and well being the arrangements that the Home makes for meals and their consumption were examined and revealed the following:- In the financial management of the Home a reasonable sum is apportioned on a monthly basis for food and housekeeping. Staff members shop at local supermarkets and other grocery outlets on a similar basis to people in ordinary households and they involve service users in this so that they are able experience and learn from this aspect of domesticity. Staff having established the foods that each service user prefers; plan weekly menus, which also take account of any special dietary needs. Records are kept showing each service users’ diet is monitored and a dietician oversees those who, for medal reasons, have special dietary requirements. From the content of menus it was concluded that service users are benefiting from a varied and nutritious diet and are afforded reasonable choice. This includes packed lunches provided for those who go out of the Home for their day occupation activities. Food in store was considered sufficient taking account of how regularly grocery shopping is done and is in keeping with what is forecast on the menus. A meal was prepared and served during the inspection and this was observed to be an enjoyable event for service users. One service user was in the kitchen observing the food being prepared, and the kitchen being near to the sitting/dining area meant that the other service users were able to experience the aroma of the meal during its preparation. The actual mealtime was relaxed, service users ate together and staff members were noted to engage them in conversations about the day’s events, etc. Ics - Ward Grove, 60 DS0000004365.V280090.R02.S.doc Version 5.1 Page 15 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 the following standard(s): 18, 19 and 20 Care planning and care practices in the Home result in service users being supported to remain in a clean, comfortable state and to be maintained in as good a health as their conditions allow. EVIDENCE: As outlined in earlier sections of this report, which focused on assessment and care planning, those in charge of the Home are judged to fulfil the required standards in establishing and in planning to meet service users’ needs arising from their health and disabilities. In this regard, evidence was seen of all the necessary aids and equipment being provided such as special beds, hoists, wheelchairs and specially adapted and equipped bathing and toilet facilities. There were also records, charting care inputs such as special diets and their effects, monitoring of epileptic episodes and the agreed strategy for responding to them. Earlier it was explained that the Home’s approach to the care of service users is considered and leaves little to chance, this is clearly demonstrated in other health monitoring activity such as weight charts so that any fluctuations in weight which might be symptomatic of illness can be brought to the attention of the specialists and, if necessary, treatment given. Ics - Ward Grove, 60 DS0000004365.V280090.R02.S.doc Version 5.1 Page 16 It was noted that as part of their individual plan there is a discrete care routine for each service user setting out how they prefer to have their personal care support provided and how they might be enabled to make choices. Although not featured in any of the individual plans staff explained that service users are for example, given options in the style and colour of clothes that they wear each day and they indicate their preference using their particular medium of communication. All these examples show that in practical terms service users are being well cared for and that mostly their care is being delivered in ways that seek to preserve their privacy and dignity. One factor did, however, give rise to concern. That is, for substantial periods during the inspection there was only one member of staff on duty who was male and when joined by another, also male, did not reflect the ratio of female service users. Since staff members assess, and the records confirm, that all the service users are highly dependent thus needing assistance with their intimate care, when there are only male staff members on duty this raises the issue of choice, and dignity for female service users. Also, taking account of the intimate nature of the care female service users require, when there is only one male member of staff on duty this leaves the service users and the sole member of staff vulnerable in terms of safe caring and the protection of vulnerable adults from abuse. The inspector hastens to add there was no evidence of any abuse, but this issue has been highlighted so that the Registered Person can take the necessary steps to address this deficit in the Home’s safe caring procedure. It was noted that service users’ health was also being promoted through a safe procedure, which is followed to ensure that their individual medication regimen is administered as prescribed. However, a quantity of medication some of which was six months old was being stored on top of the medicine cupboard. This appears to have been the case because the medicine cupboard is not large enough to store it all. It might be, in the circumstance, necessary to either replace the cabinet with one large enough to store all the medication safely or to ensure that some stores of medicines particularly that which is dispensed in bulky containers is not stockpiled. No record was available of unused or discontinued medication, which has been returned to the pharmacy for disposal, if such a record does not exist then arrangements need to be made for it to be kept. The records showed that service users’ medication is reviewed by their GPs to ensure that they remain efficacious and it was also noted that the Pharmacy conducts periodic safety audit of the Home’s medication procedure. The record of the last such audit in April 2005 showed that there were no concerns on that occasion. Ics - Ward Grove, 60 DS0000004365.V280090.R02.S.doc Version 5.1 Page 17 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 the following standard(s): Reasonable efforts are being made to find out service users’ views about how they are being cared for and preparedness to respond helpfully to any concerns that they might have. Furthermore, those responsible for the Home have taken appropriate steps to protect service users from abuse. EVIDENCE: At the last inspection the Manager explained that because service users are not able to readily communicate any concerns they might have, deliberate efforts are made to observe their reactions to the way their care is being delivered. From this staff members have come to understand and interpret from service users body language what pleases or offends them. For example, expressions such as frowns and smiles serve to give an indication of whether service users are content or displeased. This approach combined with a service users satisfaction questionnaire set out in pictorial form and periodically administered shows that the registered persons are continuing to take the steps necessary to find out service users views about their care and the running of the Home in a proactive way. There is a formal complaints procedure, which was seen and deemed to conform to the relevant standard. The procedure is clear in relation to whom complaints might be made, the process for dealing with any complaints and the timescales for so doing. Although the Manager reported that there had been no complaint at the last inspection, the inspector advised of the requirement for a record or register to be kept into which should be entered any complaints made by or on behalf of service users. No such record was seen at inspection, but the member of staff on duty said that to the best of his knowledge no complaints have been made since the last inspection. Ics - Ward Grove, 60 DS0000004365.V280090.R02.S.doc Version 5.1 Page 18 However, concerns were expressed, via Comment Card survey at the last inspection, about the impact of staff shortages and it was suggested that these be entered in the complaints record so that in future the Registered Person is able to monitor any pattern, which might be emerging in this regard. The inspector was not able to check whether this had been done because the complaints register was not available. In taking steps to ensure that service users are protected from abuse or unfavourable treatment, the Registered Person has set out guidance and a procedure for staff to follow in the event of there being any suspicion of, or actual, abuse. The guidance explains the nature of abuse and, in conjunction with the whistle blowing policy and the basic training that staff receive shows that reasonable steps have been taken to protect service users from abuse. It was noted that a copy of the local Protection of Vulnerable Adults Procedures (POVA) was still not available in the Home. The Registered Person is therefore again advised to obtain a copy of those procedures, make staff familiar with the contents and ensure that the Home’s procedure is compatible with them. This is because the locally agreed POVA procedures would be invoked in the event of any incidents of abuse at the Home. Ics - Ward Grove, 60 DS0000004365.V280090.R02.S.doc Version 5.1 Page 19 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 the following standard(s): 24 , 25 and 30 Service users continue to benefit from the homely and material comfort that the home provides and the assurance that it is maintained in a clean, hygienic state free from avoidable hazards and adapted to their particular needs. EVIDENCE: At the last inspection all aspects of the Home’s environment were deemed comfortable and safe. The only issue was damage to a drawer in one of the chest of drawer units in a bedroom, which on this occasion the inspector noted has been repaired. Apart from two of the dining chairs, which have been taken out of use because they have become unsafe, the Home’s environment including its structural and decorative condition, and fixtures and fittings remains acceptable and continues to meet service users needs. One of the members of staff who assisted with this inspection reported that he was aware of plans to replace the dining table and chairs in the near future. It was observed that the absence of the two damaged dining chairs did not have any adverse impact on service users’ comfort. It is advised that the mop and bucket, which is being kept in the bathroom is stored elsewhere, as this detracts from its otherwise homely appearance. Ics - Ward Grove, 60 DS0000004365.V280090.R02.S.doc Version 5.1 Page 20 It was also noted that all the necessary precautions were being taken to ensure that the Home remains in a clean and hygienic condition so as to minimise risk of any spread of infection and to promote good health. In this regard there are acceptable laundry arrangements, appropriate measures are in place for dealing with any clinical waste and staff are provided with protective clothing and hand washing facilities. Ics - Ward Grove, 60 DS0000004365.V280090.R02.S.doc Version 5.1 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33 and 35 Service users are being cared for by staff members who for the most part are available in sufficient numbers and have received basic training that equip them to do this competently. It will, however, be necessary for a greater number of staff members to have their competence accredited through the National Vocational Qualification (NVQ) process and be deployed in a gender ratio that gives service users choice in who provide their intimate care support and to promote safe caring. EVIDENCE: The Manager was not available during this inspection visit, and evidence in relation to staffing is based in part on data from the last inspection, records seen on this occasion and information given by staff who were on duty at the time if this inspection. The records show that there is an established programme for staff induction and foundation training, which enables them to understand how the Home operates, the nature of service users difficulties and needs and how to care for them safely. For example, staff members know how to try to engage service users in what is going on in the Home and to assist them to communicate their needs. Staff are also reported to have received training in First Aid and in Manual Handling so as to respond to medical emergencies appropriately and to assist service users with mobility difficulties safely. Ics - Ward Grove, 60 DS0000004365.V280090.R02.S.doc Version 5.1 Page 22 It was also noted that, as was the case at the last inspection, care is taken to recruit staff with attitudes and attributes necessary for caring for people with learning and physical disabilities. That is, they are approachable, committed and genuinely respect service users and are relaxed in their company. It was also gleaned from the records and staff accounts that they have a good working knowledge of the services offered by other agencies and professionals such as the Speech and Language Service and GPs, which are relevant to meeting service users’ needs; and they are able to work effectively with them. One of the quality indicators of standard 32 is that staff members should possess accreditation of their competence at NVQ level 2 or 3 or its equivalent and, if not, are working to achieve this by an agreed date. At the time of inspection only one member of staff was reported to possess NVQ 2 though staff on duty during the inspection said they were aware of arrangements for a further three staff members to be so accredited. Since this inspection the CSCI has received information that 4 of the 6 staff have achieved NVQ 2 or have qualifications achieved at this or a higher level. Other measures such as an annual staff training plan developed by the Manager to ensure that staff members are equipped to fulfil the Home’s objects and therefore the needs of service users as seen at the last inspection, were on this occasion reported as still being in place. A similar situation also exists in relation to individual staff members training and development profiles. However, in planning to meet the target for the ratio of 50 of care staff with NVQ level 2 or 3 or its equivalent, where relevant, each staff member’s profile should show the timescale within which he or she is expected to become so qualified. The Home is assessed as having an effective staff steam in most respects, but as earlier pointed out in the assessment of performance against standard 18, staff need to be deployed so that service users have some choice in being assisted in their intimate care by staff of the same gender. In stipulating this, the inspector is mindful of staff’s explanation that service users’ families are aware of, and consent to, the practice of, say, male staff assisting female service users with their personal/intimate care. The inspector’s opinion is that if this practice continues it might have the effect of compromising service users’ dignity and places them and staff at risk of abuse or allegations thereof. This being more likely when there is a sole member of staff on duty as was the case for a certain period during the inspection, which suggests the need for their more efficient deployment to ensure that there are two on duty during service users waking hours. Ics - Ward Grove, 60 DS0000004365.V280090.R02.S.doc Version 5.1 Page 23 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Service users continue to be provided with a service, which so far as possible tries to find out their views about its quality and impact on them, plans for their changing needs and assures their safety and wellbeing. EVIDENCE: At the last inspection the manager provided evidence in the form of questionnaires, which have been specifically designed for service users, their families and others with an interest in the home. These surveys seek their views about the running of the home and the quality of service users’ care. The questionnaires had only recently been administered and therefore had not been analysed at the time of that inspection. The manager was made aware that the outcomes and any proposed actions that will be taken in response to them need to be published and made available to service users, their representatives and other interested parties including CSCI. As mentioned earlier, the Manager has ensured that each service user has an individual plan for his or her care. The recent introduction of a new structure of the plan will in time make it straightforward to see the ‘year on year’ Ics - Ward Grove, 60 DS0000004365.V280090.R02.S.doc Version 5.1 Page 24 developments in each case as prescribed in standard 39.5. This measure together with the surveys mentioned above and the Manager’s action plan for areas such as staff training and development, and repairs and maintenance provide further evidence of the review and planning necessary for assuring quality of the service users’ care. Although in practice standard 39 is assessed as being met, the Homes quality assurance and quality monitoring system might be made more apparent and possibly contribute to staff induction/foundation training, if they were to be set out in writing. That is, to illustrate how information from the complaints procedure, stakeholders’ surveys, reports of visits by the Registered Provider under regulation 26 and periodic reviews of the quality of care under regulation 24 combine to monitor and assure quality. Further, the Registered person is reminded that the requirement to supply the Commission with the reports of visits conducted in fulfilment of regulation 26 and the report of periodic review of the quality of care. Note no such reports have been received since the last inspection. Checks were made to establish whether the Registered Person was ensuring that the measures for the safety of service users and staff, as outlined in standard 42 were being fulfilled. It was concluded that they were being fulfilled. That is, on the basis of precautions such as regulating the hot water temperature and testing it at regular intervals at the outlets to which service users have access were being done. Other measures such as tests of the gas and portable electrical appliances, implementation of a COSHH policy and taking the necessary fire precautions also confirmed compliance. It was noted that where service users’ conditions such as epilepsy places them at particular risk, staff have received instructions in how to respond. Ensuring, as earlier mentioned, that staff members received training in areas such as Manual Handling, First Aid and Basic Fire Safety also contributes to keeping service users safe. Ics - Ward Grove, 60 DS0000004365.V280090.R02.S.doc Version 5.1 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 3 3 X 4 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 3 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 X 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 X X X x LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 x 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x X X 3 X X 3 X Ics - Ward Grove, 60 DS0000004365.V280090.R02.S.doc Version 5.1 Page 26 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 YA20 Regulation 13 (2) Requirement The Registered Person must ensure all medicines are stored in the secure medicine cupboard. Timescale for action 28/02/06 2 3 YA22 YA33 17 (2) 18 The Registered Person must 31/03/06 keep a register in which complaints are to be recorded. The Registered Person must 31/03/06 ensure that at all times there are sufficient numbers of staff on duty in the Home commensurate with service users’ high dependency and, where possible, for service users to have the choice of a staff member of the same gender assist with their intimate care. Ics - Ward Grove, 60 DS0000004365.V280090.R02.S.doc Version 5.1 Page 27 4 YA39 24 and 26 The Registered Person must supply the Commission with the report of the service users and stakeholders’ surveys, which were conducted prior to the last inspection. 31/03/06 Ics - Ward Grove, 60 DS0000004365.V280090.R02.S.doc Version 5.1 Page 28 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 YA6 Good Practice Recommendations Where service users are not able to understand the content and implications of their individual plan, the Registered Person should seek to have the plan endorsed by the service user’s Care Manager and/or family. The Registered Person should ensure that the home’s Protection of Vulnerable Adults (POVA) procedure is in line with the local area POVA procedures and that a copy of the latter is made available to staff at the home. The results of service user surveys should be published and made available to service users, their representatives and other interested parties including CSCI. 2 YA23 3 YA39 Ics - Ward Grove, 60 DS0000004365.V280090.R02.S.doc Version 5.1 Page 29 Commission for Social Care Inspection Leamington Spa Office 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 - Ward Grove, 60 DS0000004365.V280090.R02.S.doc Version 5.1 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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