Inspection on 03/05/07 for Isaac Robinson Court

This inspection was carried out on 3rd May 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Isaac Robinson Court 15/12/05

Isaac Robinson Court 14/07/05

Isaac Robinson Court 03/03/05

Isaac Robinson Court 05/10/04

Isaac Robinson Court 22/03/04

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

The Cornerstone

John Street Nursing Home

Pennine Camphill

Whitwood House

Whitwood Hall

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

CARE HOME ADULTS 18-65 Isaac Robinson Court Arcon Drive Anlaby Road Hull East Yorkshire HU4 6AD Lead Inspector Beverly Hill Key Unannounced Inspection 3rd May 2007 09:00 DS0000000918.V334557.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000000918.V334557.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000000918.V334557.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Isaac Robinson Court Address Arcon Drive Anlaby Road Hull East Yorkshire HU4 6AD 01482 352959 01482 355652 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) Humberside Independent Care Association Limited Mr Simon Jeremy Smith Care Home 40 Category(ies) of Learning disability (40), Learning disability over registration, with number 65 years of age (40) of places DS0000000918.V334557.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. That registration is approved with the condition that Mr Smith completes the registered managers award. 15th December 2005 Date of last inspection Brief Description of the Service: Isaac Robinson Court is located to the west of Hull City Centre, and is owned by Humberside Independent Care Association Ltd (HICA), a not for profit organisation. The home is set within the local community with neighbourhood facilities close at hand and is on bus routes into the city centre. The home provides personal care and accommodation for a maximum of 40 younger adults and those over 65years old with a learning disability. The home provides both long term and respite care. The home consists of five individual bungalows, two of which have six bedrooms in each for those service users requiring respite care and three have eight bedrooms in each for those requiring accommodation on a more permanent basis. Each bungalow has an individual lounge, kitchen, bathroom, shower room and access to patio and garden space. There are also two individual flats used to accommodate up to two people in each in the main building. There is also a large function room, staff training room, the main kitchen, a laundry facility and administration offices in the main building. According to information received the weekly fees are £493. Information regarding the services provided was included in the homes statement of purpose and service user guide displayed in the home and given to each potential resident. Items not included in the fees are hairdressing, chiropody, toiletries, clothing, TV license and outings. DS0000000918.V334557.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The visit to the home was unannounced and was carried out over one day. Throughout the day the inspector spoke to service users to gain a picture of what life was like for them at the home. The inspector also had discussions with staff members and the manager. The inspector looked at assessments of need made before people were admitted to the home, and the home’s care plans to see how those needs were met. Also examined were medication practices, activities provided, nutrition, complaints management, staffing levels, staff training, induction and supervision, how the home monitored the quality of the service it provided and how the home was managed overall. The inspector observed the way staff spoke to service users and supported them, and checked out with them their understanding of how to maintain privacy, dignity and choice. This was also discussed with service users. The inspector also checked that people were supported and protected in a safe and clean environment. The inspector received surveys from the service users, their relatives and staff members. Comments have been used throughout this report and in the formation of judgements about service provision. What the service does well: Service users and their relatives are given enough information about the home to enable them to make a choice about whether it will be suitable for them or not. Families are made to feel welcome when visiting their relatives and are kept informed about what is going on. All service users are provided with a single room that meets their needs. The separate bungalows are homely in appearance and provide people with a home and private areas to their liking where they can spend time or receive visitors. The home has a consistent staff group which makes sure that the residents have someone caring for them who they are familiar with and they know and who knows them, this is especially important for the people who have very complex needs. Service users said that the staff members were nice and they were happy at the home. Staff members enjoyed working at the home and felt very supported by the manager. The staff members help people to be as independent as possible and develop new skills. Service users receive a healthy diet and their likes and dislikes are also taken into account. DS0000000918.V334557.R01.S.doc Version 5.2 Page 6 Isaac Robinson Court is located in the local community and is on a bus route making all leisure facilities and shops easy to get to. The home offers choices to service users in all of the activities and occupations provided. Holidays are arranged which are suitable to the residents needs in length and location. The staff group had very good training opportunities, which equips them to meet individual needs and care for the service users. The way the home continually checks out the quality of their care is excellent. The manager records any complaints and they are dealt with quickly. This means that they are always finding ways to improve the service. What has improved since the last inspection? What they could do better: The home makes sure that people have assessments of their needs before being admitted. The manager needs to write to people after the assessment telling them whether the home can meet their needs. The home could keep asking the local authority what they are doing for one service user who was admitted to the home for a short stay but who needs a permanent home. Several weeks have gone by since the admission and the person needs to be settled. When service users need extra attention because of their behaviour or for example if they do things but there is a risk to the activity, the home needs to make sure that they have all the information about how to manage the behaviour and risks written down in care plans. This will make sure staff members know how help people remain safe. Some service users have been prescribed new medication by their doctor and staff members need to have training to make sure they know how to administer it safely. The manager was aware of this and was waiting for the community nurses to give staff the training. When service users, because of their behaviour cause harm to other service users, the manager must report it to the local authority so they can check it out and find better ways of protecting people. DS0000000918.V334557.R01.S.doc Version 5.2 Page 7 One of the bungalows used for short stays needed redecorating and had some furniture that needed replacing. Wardrobes were lockable but staff didn’t always have the keys available if service users wanted to lock things away. The way the home completes checks on new staff coming to work at the home is usually very good. In one instance someone started work after an initial check but before the police check came back. When this happens, which is only in exceptional circumstances, the person must be closely supervised. The home needs to record any discrepancies in personal information. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000000918.V334557.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000000918.V334557.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 and 4 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users needs are assessed prior to admission, which means the home is able to gather information to determine whether they are able to meet peoples’ needs. Service users are provided with the opportunity to visit and sample the home before a decision is made about long term residency. The extended respite stay for one person does not offer the continuity of service they require. EVIDENCE: The inspector examined three service user care files, two of which were from service users recently admitted to the home. All the files had copies of assessments and care plans completed by local care management teams. The manager also completed his own in-house assessment prior to admission. This enabled them to check out if circumstances had changed since the professional assessment had been completed and also to start a more individualised process of information gathering. Assessment information was crucial in the decision making process as to whether the home was able to meet peoples’ needs and was used when formulating plans of care. The home needs to formally write to service users or their representatives following assessment stating their capacity to meet needs. DS0000000918.V334557.R01.S.doc Version 5.2 Page 10 After admission there was evidence that the assessment process continued examining ‘support areas’ until sufficient information was gathered to enable formulation of a care plan. One service user was living at Isaac Robinson Court on an extended respite basis whilst the local authority found a more long term home for them. The service user had complex health and personal care needs and whilst the staff worked very hard to meet their needs the environment they stayed in was ever changing as people used the respite service for short stays. The manager and staff team recognised the impact this had on the service user. Staff surveys had stated that the respite service supported people with ever increasing complexity of needs but staff deployment did not always match up. The manager needs to continually review the situation with the local authority to speed up decision-making for the specific service user. Two of the service users had been admitted from another residential home and the inspector was able to see planned introduction arrangements of visits and overnight stays prior to admission. Advocacy services had been involved in supporting the service users decision-making. The manager confirmed that the home offered respite services for a large number of people and had two designated bungalows identified for this purpose. Respite enabled service users to sample the services the home provided. One service user stated, ‘I came for a lunch visit first and did some baking’ and another said, ‘I came to stay for a short while and my old home wouldn’t let me go back and so I ended up here’. DS0000000918.V334557.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users needs were generally well planned for in care support plans, they were kept under review, and the documentation gave good guidance to care staff. However the lack of a behaviour management plan for one service user means that staff do not have clear guidance around consistent approaches to care. The home enabled service users to actively take part in decision-making and taking risk was seen as part of their choice in how they wish to live their lives. Deficiencies in risk management of one service user have meant that two service users have been harmed and a lack of risk assessments in two other areas means that identified risk are not planned for. EVIDENCE: The inspector looked at a range of care files and examined three care support plans in detail, two formulated for service users recently admitted to the home and a further care support plan for a person who receives regular respite. Two DS0000000918.V334557.R01.S.doc Version 5.2 Page 12 were more detailed, but it was acknowledged that the home was still in the process of information gathering for one of the service users. This latter care support plan needed more comprehensive information regarding staff intervention when the service user has disputes with other people and communicates perceived problems. The plan described the disputes and the service users reaction to them but not what staff members need to do to support them. One service user required a behaviour management plan to address behaviours that were challenging and harmful to other service users and staff. Whilst this was acknowledged as important at a review meeting and to be produced by health professionals, the home had not followed this up. This meant that staff members did not have clear guidance on how to be consistent with their approach with certain behaviours and some service users had expressed concerns to staff about sharing communal space with the service user. Service users were enabled to take responsible risks as part of an independent lifestyle. Risk assessments were in place, for example for moving and handling, nutrition and arrangement of furniture for one of the service users whose care file was examined. One care file examined required that a risk assessment be completed for bedrails prior to the service users next admission for respite, if they were to have them insitu during the visit as usual. Another service user had identified risks of choking and moving and handling issues but no risk assessment with how staff members were to minimise the risks was in place. The manager confirmed that some service users signed risk assessments as confirmation that they are aware of the need to minimize risk. The care support plans generally covered needs identified in assessments and gave good direction for staff in how to meet them, for example with personal care support. There was evidence that privacy, dignity, choice and independence were encouraged. Care plans were signed by service users where possible or their representatives. There was a system of reviewing daily recording on a monthly basis and reviews of care plans were held. Residents told the inspector that they were given choices in their daily activities and there was evidence in care plans that they attended their own reviews. One service user stated, ‘I decided to do activities and attend social clubs myself – I also make choices about my life and say things in meetings’. Another service user said, ‘I like to play my CD’s loud in my bedroom, not at night though’. Where residents need help to make decisions, staff are able to demonstrate why these decisions have been made and explain the reasons. There was evidence of advocacy support to two service users during the decision-making and transition from one residential home to Isaac Robinson Court. Staff members supported people to manage their finances. DS0000000918.V334557.R01.S.doc Version 5.2 Page 13 The key worker system and residents meetings enabled everyone to be involved in wider decision making within the home. Eight surveys were received from service users and all had ticked the boxes stating they can choose what they want to do during the day, at night and at the weekends. DS0000000918.V334557.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17 People who use the service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users are part of the local community and are enabled to take advantage of local facilities and opportunities for personal growth. The home promotes and encourages service users relationships with family and friends via contact and inclusion in organised activities. The home provides a well balanced diet thereby meeting the nutritional needs of service users and offering choice and alternatives. EVIDENCE: The home is located within the local community on a bus route into Hull city centre and close to facilities such as shops, pubs, churches and cafes. As such service users have the opportunity to access these facilities. There was evidence that service users attended a range of social clubs, training centres, colleges and educational facilities. DS0000000918.V334557.R01.S.doc Version 5.2 Page 15 The home employed an activity coordinator for five hours a day, five days a week. Service users not attending Hull Further Education College or CASE Training participated in a range of activities provided in the main building. The inspector observed a planned craft activity during the day of the visit. Two relatives visiting at the time were welcomed into the group. There were plenty of materials and service users clearly enjoyed the activity. One service user took great enjoyment in showing the inspector a collection of their work completed during the last few weeks. One survey from a service user indicated they were bored sometimes at the weekend. This was mentioned to the manager to investigate. The activity coordinator, although only in post for the last few weeks had clearly made an impression as one relative spoken to on the day stated, ‘the home is brilliant, and the activities are very good. The activity coordinator is new in post, but she knows the residents – one person is bedridden but she spends one to one time with her’. One relative survey stated, ‘there are lots of activities and a range of access to facilities for service users’. Staff members in discussions, and via surveys, commented on the range of activities and outings available and felt this was one area were they excelled. These included movement to music, craft sessions, pool, bingo, karaoke, computer work, games, baking, making music, trips out, visiting entertainers and local shopping. Service users had the opportunity to have annual holidays and one relative explained that this year these had been organised to Scotland, Blackpool and ‘somewhere in the country’, to ‘cater for all tastes’. As some service users had not flown before the trip to Scotland included return flights. Observation and discussion with service users indicated that staff members continue to interact very well with service users. There was a warm, friendly and relaxed atmosphere throughout the bungalows during the course of the day. Relatives spoken with and surveys received from them indicated that staff kept them informed of important issues and supported service user users to keep in touch. Some comments were, ‘whenever I ring through I am given details of her well being and behaviour, mood etc and she in turn is told that its her mum on the phone’, ‘We are kept up to date with issues connected to all activities and future programmes etc at the monthly meetings with the staff at the home’ Two service users live in individual flats within the main building. This enables them to have a degree of independence and self-reliance yet also to have staff support at hand when required. One of the occupants stated, ‘I do my cleaning in my flat on Wednesdays, I make choices about my life’. DS0000000918.V334557.R01.S.doc Version 5.2 Page 16 One visitor commented to the inspector that their relative was extremely happy at the home and when they return after a day out always says, ‘home sweet home’. The home provides service users with a varied and nutritious diet and as a result has obtained the Heartbeat Award. Menus are planned over four weeks and service users are offered a choice at each mealtime. The staff members responsible for serving the meals know service users’ likes and dislikes and surveys received from them included good comments about the choices of food available, its preparation and presentation. Service users spoken with during lunch spoke positively about the quality and choice of the meals provided. Comments included, ‘the food is very good’, and ‘I like to have soup’. The inspector observed plentiful supplies of a range of sandwiches and crisps and one service user, had requested and had been provided with soup instead. One staff member stated in a survey, ‘I feel a more user friendly format of menus with pictures of dishes would be helpful’. This was discussed with the manager who stated they were currently reviewing the menus to make them more user friendly by including symbols. However this was brought up at an inspection eighteen months ago and is still to be addressed. DS0000000918.V334557.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users received personal support, and had access to health services in ways that promoted their independence, choice, privacy and dignity. Generally the management of medication is well maintained, however new developments in medication require staff training. Without it care staff may not have the up to date skills they need to administer the medication properly. EVIDENCE: The home continues to work in partnership with health professionals to ensure that the ongoing health needs of service users are addressed. There was evidence of input from GP’s, consultants, community nurses, specialist epilepsy nurses, dentists, opticians, chiropodists, speech and language therapists, physiotherapists and occupational therapists. The home had completed health action plans for each service user that detailed areas of health that required support and intervention. Various monitoring charts were used when it was identified service users had particular risk areas, for example, epilepsy, bowel management or nutrition and fluid DS0000000918.V334557.R01.S.doc Version 5.2 Page 18 intake. Service users spoken to confirmed that they see a variety of health professionals. Care plans detailed how privacy and dignity was to be promoted and staff members spoken to described ways in practice that this occurred. A domestic staff member informed the inspector they would not dream of using the master key to enter service users locked bedroom doors without first obtaining their permission. Service users spoken to and surveys received from them, confirmed staff members supported them in ways that respect their privacy and dignity. One relative spoken to during the visit was very complimentary about the care staff team and stated, ‘I overheard two care staff talking to someone and they didn’t know I was there. They spoke to her in a very nice way, not patronising at all’. They felt their relatives’ hair was done how she liked it and she always had her jewellery on. Another relative in a survey stated, ‘All the staff I have so far encountered display a sense of understanding and patience, combined with a warmth and gentle type of humour’. There is a detailed medication policy in the home regarding the handling of medication. Records examined indicated that medication was signed on receipt into the home and on administration. Stock control was appropriate and the home had good support from the local pharmacist. Controlled drugs were stored and recorded as such. One survey received from a relative stated, ‘the staff maintain and administer her complicated mixture of medication’. The inspector discussed with the manager the need for best interest meetings and staff training when the drug, Midazolam, is prescribed orally instead of the more invasive rectal Diazepam to control prolonged seizures. As buccal Midazolam is, as yet still unlicensed, best interest meetings must explore the decision-making process surrounding its use. The manager will ensure documentation around best interest meetings is in place and was aware of the need for staff training in administration. One service user who receives respite care will continue with previous medication arrangements until all staff members have received the training. The organisation has developed a medication-training package, however the inspector could not see evidence that staff had a formal competency check by someone qualified to do so. The manager provided individual staff training histories as part of the pre-inspection information dated March 2007 and when examined ten care staff had completed medication training. Seven of these were dated 2002, two were updates completed in 2006 and one indicated a course was booked in May 2007. Five care support workers had completed training, however staff confirmed only team leaders or care support managers would administer medication. DS0000000918.V334557.R01.S.doc Version 5.2 Page 19 Service users aiming for greater independence would be enabled to self medicate as appropriate. The manager explained that an assessment and agreement would be in place and lockable facility provided. However none of the current service users self medicate. DS0000000918.V334557.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides an atmosphere whereby service users and visitors feel able to complain. Although staff members have received training in safeguarding adults and policies and procedures are in place some service users have been harmed. A failure to follow the policies and procedures in practice has meant that the measures put in place have not completely resolved the issues. EVIDENCE: The home had a complaints policy and procedure that was displayed in the home in an easy read format. Surveys indicated that staff members were aware of the complaints process and there was evidence that complaints were recorded and investigated. Relatives spoken to knew the managers name and stated they would report any concerns directly to them. One relative described how they attended carers meetings arranged in the home and could express any concerns or complaints at these meetings. Staff members received training in the protection of vulnerable adults during their induction and staff and the manager were aware of the multi-agency policies and procedures regarding alerting and referral. However during the visit the inspector noted that two service users and some staff members had been subjected to hair pulling and nipping by a service user. The home had attempted to deal with the incidents and care plan reviews had been called with health and social care professionals present. Some steps had been taken DS0000000918.V334557.R01.S.doc Version 5.2 Page 21 to prevent further injuries, however they had continued resulting in distress for the service users and a formal complaint by a relative. The lack of a thorough behaviour management plan has resulted in insufficient guidance for staff. The inspector noted several service users congregated in one of the lounges in one of the respite bungalows and staff members explained that some service users were frightened of using the other lounge for fear of being hurt by a particular service user. The manager was advised to report the series of incidents to the local authority safeguarding adults’ team, which they did on the day of the inspection visit and to take guidance about any further action required. The home must ensure that service users are protected and feel safe in their environment. DS0000000918.V334557.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 28 and 30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users live in a clean, comfortable and homely environment. The wellbeing and comfort of service users visiting the home for short stays would be enhanced by speedy replacement of specific items of furniture. EVIDENCE: The home consists of five individual bungalows, two of which have six bedrooms in each for those service users requiring respite care and three have eight bedrooms in each for those requiring accommodation on a more permanent basis. Each bungalow has an individual lounge, kitchen, bathroom, shower room and access to patio and garden space. There are also two individual flats, in the main building, used to accommodate up to two people in each. DS0000000918.V334557.R01.S.doc Version 5.2 Page 23 There is also a large function room, staff training room, the main kitchen, a laundry facility and administration offices in the main building. Service users spoken to were happy with their bedrooms and those seen were personalised to varying degrees. On the day of the visit the home was clean and tidy and the individual bungalows provided a homely and comfortable environment for service users to live in. One relative stated in a survey, ‘they provide a safe environment for its users and gives care and protection while allowing the residents a degree of freedom within the home’. Bedrooms had lockable wardrobes but keys were not always available and one of the bedrooms had a chest of drawers with broken handles. The manager will discuss in service users meetings the option of providing lockable facilities for people and will attend to the furniture item. One of the bungalows used for short stays had been decorated but the other had furniture and décor in communal areas and bedrooms that was looking jaded and in need of replacement. The lounge carpet was also in need of cleaning. The manager advised quotes had been obtained to replace some of the furniture but this had yet to be sanctioned. The bedrooms in the respite bungalows were, because of the very nature of their use, less personalised as service users stayed in them for short periods of time. The home had sufficient laundry equipment in a designated area and policies and procedures were in place for the control of infection along with the provision of protective clothing. The carpet cleaner had been out of action for a short while but staff advised this had been rectified and the carpet in the respite bungalow lounge could now be cleaned. DS0000000918.V334557.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has a good staff training and supervision record, which means that staff members are well supervised and have opportunities to participate in mandatory and service specific training. Generally the company had sound recruitment processes, however a gap in the process identified during the visit may place service users at risk. EVIDENCE: The company ensured that new staff members completed a five-day block of induction, which included training in fire procedures, safeguarding vulnerable adults from abuse, moving and handling, learning disability awareness, health and safety, basic first aid and social care values. Two staff members were progressing through the learning disability award framework (LDAF) induction, which covered required standards in five separate modules and which will ensure that competency is assessed throughout the process. This will be an improvement on previous induction, as records examined showed that induction tasks were just signed off by senior staff but did not evidence any competency in care practices. DS0000000918.V334557.R01.S.doc Version 5.2 Page 25 The home had a training plan and there was evidence that mandatory and service specific training was covered. Each staff member had a personal training plan that recorded the training participated in. According to information received from the manager during the visit the home had 25 of care staff trained to national vocational qualification level 2 and 3, however a further twelve care staff were progressing through the training. When staff members have completed the training the home will have exceeded the requirement of 50 of care staff trained to these levels. Although the home had sufficient staff in terms of numbers, staff members spoken with and staff surveys received from them indicated a level of concern regarding staffing numbers at times. This mainly appeared to relate to days when service users did not access day care or educational facilities when one staff member alone would be supporting six or eight service users, depending on whether they worked in the respite bungalows or with service users requiring longer term care. Staff also indicated that the arrangements for respite planning could be further improved to ensure a more compatible mix of service users and awareness of the increasing needs of some service users. Via discussion with the manager it was clear they were aware of staffing issues and changing needs. He confirmed that discussions were taking place with commissioners regarding the focus of care support for one of the bungalows. The manager confirmed that staffing levels in the respite service fluctuated based on the needs of the occupants. Service users and relatives spoken with and surveys received were complimentary about the care staff team. Comments were, ‘if I have concerns about my relative the staff are there for me, they are brilliant’, ‘I feel great understanding and thoughtful consideration is shown to our daughter’, ‘all the staff are good’, ‘I like the staff’. Generally the home operated a robust recruitment process. References and criminal record bureau checks were obtained and checks made against the protection of vulnerable adults register. Care staff members were selected via an interview process. Usually staff only started work in the home after the return of the criminal records bureau check, however on one occasion a staff member started employment after the return of the povafirst check but before the criminal record bureau check had returned. In exceptional circumstances this is acceptable but the home must put in place stringent supervision arrangements and the inspector could not see evidence of this. The same person had discrepancies in their documentation and there were no accompanying records to explain why. The manager sought explanation from HICA headquarters on the day of the inspection and information is to be forwarded to the Commission. DS0000000918.V334557.R01.S.doc Version 5.2 Page 26 There was evidence that staff members were supported by the provision of regular supervision. Staff felt supported by the manager and surveys commented on his supportive and approachable manner. One staff member indicated that supervision fell short of expectations and had ceased to be a two way process. This was mentioned to the manager to address with the staff member and their supervisor. DS0000000918.V334557.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home was generally well managed with a good system of monitoring the quality of service the home provides. Some gaps in the management of health and safety within the home need review to enhance the wellbeing of service users. EVIDENCE: The registered manager is a RNLD (Registered Nurse Learning Disability) and has maintained his registration with the Nursing Midwifery Council. He has also completed the Registered Managers Award. Staff and relatives spoken to and surveys received commented on the managers’ supportive and approachable style, ‘this is a good company to work for, the manager gets things done’, ‘it’s a good atmosphere and the morale is good most of the time’, ‘the manager is DS0000000918.V334557.R01.S.doc Version 5.2 Page 28 very good, last year I broke my pelvis so the manager made sure my sister (service user) came to see me, they even picked me up and included me in an outing’, ‘the manager instilled confidence in me to approach them again’, ‘any issues are resolved in a professional manner’. Meetings were held for service users and staff and a carers group was held at the home on a monthly basis. There was evidence that the views of service users, staff and relatives were listened to and acted on. The home has a comprehensive quality assurance system in place, which consists of audits and questionnaires to seek the views of all stakeholders. The quality audit tool focuses on all areas of service provision with different tasks each month. Results of audits and questionnaires are analysed and plans produced to rectify any shortfalls. The manager keeps a monthly record of the action taken to address shortfalls and keeps senior managers informed of progress. The company produces an annual development plan, which looks at the organisation as a whole as well as each individual home. Documentation indicated that moving and handling equipment was serviced regularly and fire drills and alarms completed. Staff completed health and safety training in induction and safety posters were on display in the home. One service user care file examined indicated that a bed rail was used during their short stay but the inspector could not see that a risk assessment had been completed. This was important to assess the ongoing need for the bed rail, the suitability of the service users bed for the rail, and the type of rail required, in relation to the service users build etc. Two service users and some staff members had been subjected to hair pulls and nipping by one service user. Whilst some steps had been taken to try to minimise the risks the situation had not been resolved and the health and welfare of the service users and staff had been compromised. Other service users choices had been limited by the situation. The manager needs to be more proactive in alerting the safeguarding adults team in these situations to enable review and allocation of resources by the commissioning bodies. DS0000000918.V334557.R01.S.doc Version 5.2 Page 29 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 2 4 X 5 4 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 2 27 3 28 4 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 3 34 2 35 4 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 4 X X 2 X DS0000000918.V334557.R01.S.doc Version 5.2 Page 30 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 YA3 Regulation 14 Requirement The registered person must ensure that the home formally writes to service users or their representatives following assessment stating their capacity to meet identified needs. The manager must continue to review with the local authority their decision to place a service user in an extended respite situation, creating a lack of continuity for them, when they require long term provision. The registered person must ensure that a behaviour management plan is formulated with professional input for one service user with behaviours that are challenging and harmful to service users and staff. The registered person must ensure that a specific service user has a thorough risk assessment in place regarding their behaviour and limitations this places on DS0000000918.V334557.R01.S.doc Timescale for action 08/06/07 2 YA6 14 & 15 08/06/07 3 YA9 13(4) 08/06/07 Version 5.2 Page 31 others. 4 YA9 13(4) The registered person must ensure that service users with identified risks have them planned for with clear steps in how to minimise the risks. 13(2) & 18 The registered person must ensure that staff members receive appropriate training regarding the administration of buccal midazolam to ensure they feel confident and competent with its use for prolonged epileptic seizures. Training to take place prior to any administration of the drug. 12(1)(a)&13(6) The registered person must ensure that all levels of staff are aware of and put into practice the referral systems regarding safeguarding adults from abuse. The home must ensure that two specific service users are protected from harm by initiating the safeguarding adults procedure and taking direction and guidance from the safeguarding adults team. 23 The registered person must ensure that the redecoration and refurbishment of one of the respite bungalows takes place to ensure the comfort and wellbeing of the service users who stay there. 18 &19 The registered person must ensure that stringent supervision arrangements are in place in the exceptional circumstances when staff start work after the povafirst check but prior to the return of the criminal record bureau check. DS0000000918.V334557.R01.S.doc 08/06/07 5 YA20 30/06/07 6 YA23 08/06/07 7 YA24 31/08/07 8 YA34 08/06/07 Version 5.2 Page 32 9 YA34 19 10 YA42 13(4) The registered person must ensure that discrepancies in details on recruitment documentation are verified and explanations documented. The registered person must ensure that any service user requiring bedrail provision has a full and thorough risk assessment and checking system in place prior to their use. 08/06/07 08/06/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA20 Good Practice Recommendations The manager should ensure that best interest meeting documentation is in place regarding the administration of buccal Midazolam, as the license for the medication in this form has not been extended yet. The manager should discuss the provision of lockable storage space in bedrooms with service users and provide equipment as required. The home should continue to work towards 50 of care staff trained to NVQ Level 2 and 3. The manager should discuss with staff the issues raised in surveys regarding deployment of staff throughout the unit and perceived shortages. The manager should discuss with staff the issues raised in surveys regarding admissions to respite services of service users with increased needs and compatibility match. 2 3 4 5 YA26 YA32 YA33 YA33 DS0000000918.V334557.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI DS0000000918.V334557.R01.S.doc Version 5.2 Page 34 - 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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