Inspection on 10/10/06 for James Burns House

This inspection was carried out on 10th October 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

James Burns House 26/09/07

James Burns House 19/12/05

James Burns House 23/05/05

James Burns House 27/01/05

James Burns House 21/07/04

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

CARE HOME ADULTS 18-65 James Burns House Greenways Avenue Bournemouth Dorset BH8 0AS Lead Inspector Heidi Banks Key Unannounced Inspection 10 11 & 16th October 2006 20:15 th th DS0000004006.V317714.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 DS0000004006.V317714.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. DS0000004006.V317714.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service James Burns House Address Greenways Avenue Bournemouth Dorset BH8 0AS 01202 523182 01202 533058 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) www.leonard-cheshire.org.uk Leonard Cheshire Claire Hough Care Home 21 Category(ies) of Physical disability (21), Physical disability over registration, with number 65 years of age (21) of places DS0000004006.V317714.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th December 2005 Brief Description of the Service: James Burns House was purpose built to accommodate up to twenty-one younger adults with varying physical needs and abilities. It is one of a number of services run in the South West Region by the Leonard Cheshire Foundation. The home is situated in a small complex which includes sheltered housing. It is close to all local facilities, including two post offices, library and a shopping centre. The home has a fleet of vehicles to support residents in accessing their community. Accommodation is in single rooms. There are two communal lounges / dining areas and shared toilet and bathroom facilities for residents. James Burns House is well equipped with specialist aids and adaptations to meet the assessed needs of residents. There is level access into all parts of the building and surrounding gardens and ample car parking facilities. There is a large annexe for the storing and recharging of electric wheelchairs. The current fees for residents at James Burns House range from £577.22 to £950 per week based on assessment of individual needs. DS0000004006.V317714.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection which took place over approximately fourteen hours on three weekdays; 10th, 11th and 16th October 2006. There are twenty permanent residents living at James Burns House at the present time. During the course of the inspection the inspector was able to meet and talk with eleven residents. The inspector was also assisted by the home’s Registered Manager, Claire Hough, the two Senior Team Leaders and two Team Leaders. A sample of records was examined including some policies and procedures, medication administration records, health and safety records and service user and staff files. The inspector was also able to take a tour of the care home. Eighteen completed service user surveys were received in addition to four comment cards from relatives, two telephone calls from relatives and visitors to the home, one comment card from a social care professional and two from general medical practitioners who have contact with the home. A preinspection questionnaire completed by the registered provider was also supplied. Information obtained from these sources is reflected throughout the report. Twenty-three standards were assessed during this inspection. What the service does well: There was sufficient evidence in service user records to show that information about individuals’ care needs had been obtained prior to their admission to the home. The assessment process clearly involved the service user to ensure that their preferences and views of their needs were documented. Systems and procedures are in place to promote the rights of service users to be involved in the running of their home including Residents Meetings, the appointment of Residents’ Representatives and input from the Leonard Cheshire Service Users’ National Association. Service users’ health care needs are met through liaison with generic and specialist health care services. Staff demonstrate a clear understanding of the diverse needs of service users and one general medical practitioner who has contact with service users at the home stated in a comment card that the home offers ‘good holistic care’. Procedures in place for medication administration are robust and ensure that service users are adequately protected. Procedures on abuse prevention and staff training in abuse awareness are in place to ensure service users are protected from harm. DS0000004006.V317714.R01.S.doc Version 5.2 Page 6 Plans are in place to address refurbishment issues in the home and ensure that the environment is improved for the benefit of service users. The home is clean and an infection control policy is in place to promote good hygiene and ensure that service users are protected from cross-infection. Recruitment procedures are sufficiently robust and therefore service users are protected from harm by those employed to work with them. Training for care workers is well-organised and covers both mandatory courses and specific training relevant to the service user group. Staff are encouraged to achieve National Vocational Qualifications in Health and Social Care and training records showed that they are suitably trained to support service users with their personal care needs. There is a management and staffing structure in place at the home to ensure that clear lines of accountability exist and staff are appropriately supervised in their work with service users. Procedures are in place to monitor all aspects of health and safety in the home and ensure that service users’ welfare is promoted. What has improved since the last inspection? What they could do better: As a result of this inspection seven requirements and six recommendations have been made. This included two requirements for the provider to address as a matter of urgency. From the sample of records inspected, there was insufficient evidence to demonstrate that service users’ needs are reviewed on a regular basis by the home in conjunction with the service users’ placing authority. This must be addressed in order for the service users concerned to know what options are available to them in terms of their placement and to be confident that they are in the right place for their needs to be met. An urgent requirement was made following the second day of inspection to ensure that this issue is addressed. Some shortfalls have been identified with regards to the lifestyle of service users within the home, particularly with regards to provision of suitable activities. Four service users spoken with stated that there were not enough meaningful activities on offer to them to meet their needs for social DS0000004006.V317714.R01.S.doc Version 5.2 Page 7 stimulation. This was also echoed in comments received by three visitors to the home who also felt that there was not enough stimulation for service users. An urgent requirement was made following the second day of inspection for the home to review the activities on offer to residents. The Registered Manager has responded to this promptly and consultation with service users has been initiated with regards to this issue. Documentation regarding the food intake of service users had not always been fully completed and this must be addressed so that anyone reading the records can identify whether the diet on offer to individuals is nutritionally adequate to meet their needs. Specific shortfalls in the delivery of personal care to individuals were identified during the inspection process and passed to the Registered Manager for action to ensure that service users’ needs and preferences are met and that any risks to service users are minimised. This includes the need for the home to review their staffing levels to ensure that service users do not have an extended wait for a response to their buzzer and can be supported with their personal care needs in a way that is sensitive to their dignity. Six out of the eighteen service users responding to the survey indicated that they did not know how to make a complaint. Two out of four service users’ relatives also indicated in comment cards that they were not aware of the home’s complaints procedure. The registered provider must therefore take appropriate action to ensure that service users and their relatives / representatives are fully aware of how they can raise concerns should they wish to. Although systems are in place to deliver fire safety training to care workers, the provider must ensure that where staff miss the training due to, for example, sickness, they receive the training promptly upon their return to ensure that they know how to keep service users safe. Service user plans and risk assessments were not always organised in a way that ensures up-to-date information is readily accessible to care workers and ‘old’ information is archived. This must be addressed to ensure that information about service users’ needs and preferences is current. Service user plans and risk assessments had also not always been reviewed in a timely manner to ensure that information remains accurate and relevant to the service user concerned. Where service users have actively made choices about the care they wish to receive and personal goals they want to pursue, these should be evaluated on a regular basis to ensure that their needs are being met by the service. This should be documented in the service user plan. Two of the four comment cards received from service users’ relatives indicated that they did not feel they were kept informed about important issues affecting their relative. It is therefore recommended that the registered provider looks DS0000004006.V317714.R01.S.doc Version 5.2 Page 8 at ways in which the home can involve and consult with service users’ relatives, with service users’ agreement. Any future refurbishment of the premises should take account of the fact that wash basins in service users’ rooms are not always fully accessible to them. This should be addressed in any refurbishment plan for the home to ensure that service users’ bedrooms promote their independence. Fire drills should be carried out at various times of the working day including times when there is reduced staffing in the home to ensure that staff can respond competently and that service users can be kept safe. Records should identify the names of service users who were present for the drill to ensure that they all have the opportunity to participate in a drill over a period of time and are familiar with procedures. 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. DS0000004006.V317714.R01.S.doc Version 5.2 Page 9 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 DS0000004006.V317714.R01.S.doc Version 5.2 Page 10 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are only admitted to James Burns House on the basis of a full assessment of their needs which takes account of the views and preferences of the service user. EVIDENCE: The records of one resident admitted to the home since the last inspection were reviewed. This showed evidence of an assessment having been undertaken by the home prior to the service user’s admission. The assessment included information on communication and sensory difficulties, mobility, transport, self-care, emotional health, social relationships, household management and ability to manage budgets and risks. Each aspect of the individual’s personal care needs had been covered in an ‘Assessment of Personal Support Requirements in a Residential Setting’. This took account of the service user’s level of independence in each area of personal care and had been completed in partnership with the service user. DS0000004006.V317714.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service user plans contained a lot of useful information about service users’ needs but were not organised in such a way to ensure that current information is easily accessible and to show how the service is supporting service users to meet their personal goals. Service users are enabled to make decisions about their lives and the running of the home but lack of staff was identified as being an obstacle in ensuring that choices made by residents are always carried out. Although there was evidence of specific risk assessments in place for individual service users there was insufficient evidence to demonstrate that these had been kept under review and were still relevant for service users. DS0000004006.V317714.R01.S.doc Version 5.2 Page 12 EVIDENCE: A sample of individual plans were reviewed. These contained a ‘personal care overview’ which gave information about the service users’ routine. The personal likes and dislikes of the resident had been covered, for example, ‘X likes to go to bed at 8pm. X likes to be up between 8 and 9am, sometimes later at weekends’. Individual likes and dislikes had also been included in the plans and there was information about service users’ level of independence in personal care tasks ‘I am able to give clear instructions regarding my choice of soap, washing implement and application of creams / choice of clothing’; ‘I will lean forward for a carer to put my sling in place’; ‘Please support my head when raising the hoist’. The amount of detail in each plan varied and in some cases could be expanded upon. For example, the goal-setting process in one plan was clearly linked to skills and interests identified by the service user and had been recorded in terms of the action needed, timescale and people to be involved. This document had been signed by the service user. However, this had been completed in early 2005 and there was no evidence of evaluation since this time to show how the service was supporting the service user in meeting his goals. Evidence of goal-setting processes was not present in all service user plans. This issue was also highlighted in feedback to the Commission from a social care professional who observed that on reviewing a service user at the home ‘interventions set twelve months earlier on the client’s care plan had not been actioned or met’. In addition some individual support plans had not been reviewed by the dates specified in the plan and not all documentation had been dated. Service user records were seen to include a combination of old and new information and it was difficult to identify which information was current and which was out of date. Two service users spoken with stated that they did not feel the service provided at James Burns’ House met their needs. In one case, the service user’s needs had not been fully reviewed by the placing authority for three years. An urgent requirement was made for the home to ensure that the service user concerned is fully reviewed by the home in conjunction with the placing authority and his options explained to him. Discussion with the Registered Manager indicated that systems are in place in the home to involve residents in decision-making. Documentation in service user records showed that service users had been involved in their review meetings and the formulation of their support plans. For example, one service user’s night support plan states ‘I would appreciate the night team visiting me between 9.40pm and 10.15pm to enable us to agree a mutually convenient DS0000004006.V317714.R01.S.doc Version 5.2 Page 13 time for me to be assisted to bed. If at all possible I would like to arrange an agreed time to be assisted up in the morning too.’ Discussion with residents during the inspection indicated that although they are enabled to make decisions, lack of staff meant that at times, their preferences are not always carried out. One service user spoken to stated that he usually has to wait about an hour over his preferred time to go to bed as staff are very busy and unable to support him at his preferred time. The home has two Residents’ Representatives who attend management meetings on a regular basis. They are responsible for obtaining and voicing the views of residents at these meetings and acting as a liaison between managers and residents. This enables service users to contribute to decisionmaking within the home. Leonard Cheshire has a Service Users’ National Association (S.U.N.A) and there was evidence by way of posters around the home that a representative of S.U.N.A. had attended a Residents’ Meeting the previous week. In discussion, the Registered Manager identified ways in which existing systems could be improved to promote better communication in the home. There was evidence of risk assessments on service user files. For example, for one service user who wishes to smoke in his bedroom a risk assessment had been carried out to enable him to do this while ensuring risks are minimised. This had been signed by the service user and care worker. Specific risk assessments had also been carried out for service users accessing the community by their preferred means. For one service user where there had been incidents of choking the Registered Manager confirmed that a risk assessment had been undertaken but this was not on file at the time of inspection. Another service user had a risk assessment on file regarding the use of ‘cot sides’ on his bed dated July 2005. Staff spoken with confirmed that ‘cot sides’ were no longer in use for this resident. This is further indication that service user files should be better organised to ensure that information that is out-of-date is archived and only relevant risk assessments are in the current service user plans to avoid confusion. A series of risk assessments for one service user were seen to be written in 2003 and 2004 regarding scalding and traffic awareness but there was no evidence that these had been reviewed since this time. DS0000004006.V317714.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The range and frequency of activities on offer to service users is generally inadequate to meet their needs for personal development, social stimulation and promote participation in their community. Service users have contact with their family and friends as they wish although family members did not always feel that they had been kept informed by the home about issues affecting their relative. The rights and responsibilities of service users are generally recognised by the home and systems are in place for them to raise issues that are important to them. Records of individuals’ daily food intake were not fully completed and therefore do not provide enough information to determine whether service users are being offered a diet that meets their needs. DS0000004006.V317714.R01.S.doc Version 5.2 Page 15 EVIDENCE: This inspection of the service commenced at 2015 hrs. This was in response to a concern raised with the Commission that there are insufficient activities in place for service users and that as a result service users tend to go to bed early. It was evident that only three service users were making use of the communal lounge facilities including one who was doing a crossword and another drinking a hot drink. The remaining service users were in their bedrooms, most of them watching television or listening to music. Discussions with these service users indicated that it had been their choice to retire to their rooms after their evening meal, one stating that she prefers to keep herself to herself. However, four service users spoken with stated that there was nothing else to do; ‘I choose the time I go to bed (7pm) but this is only because there is nothing else to do’; ‘it is very anti-social here’; ‘‘I would like more in-house entertainment as there is nothing to do here’. One service user commented that staff did not always have the time for 1:1 activities; ‘I used to do the crossword in the mornings but there are not always staff around to help me’. Discussion with some service users indicated that during the day they attend various activities including Pottery, Art and Craft and various day centres. Some service users stated that they felt this met their needs; ‘I am quite content’; ‘I find there is enough to do’. However, others felt that the activities on offer to them were inadequate and did not promote their independence or meet their wishes; ‘They organise card-making activities but hardly anyone attends’; ‘if I complain about the lack of activities staff just suggest that I organise something’; ‘I like it here but there are not enough activities on offer’; ‘When I go out it is only for a maximum of two hours and then I have to come straight back’. One service user stated that he had expressed an interest in gardening but instead of being given the opportunity to go to the garden centre and choose what he wanted to plant he had been given a packet of seeds by staff. Another service user commented that before coming to James Burns House she had enjoyed swimming – she had not been given this opportunity since moving to the home. Comments from three visitors to the home including one relative indicated that they perceived the activity programme as a significant issue affecting the service user with whom they have contact; ‘X does not get any quality 1:1 or social stimulation and is isolated’; ‘insufficient activity and stimulus resulting in boredom and inertia’. Service user plans showed very little reference to how the home intends to support service users in working towards goals related to social activity and personal interests. Three service users spoken with stated that they did not feel the home promoted their independence. DS0000004006.V317714.R01.S.doc Version 5.2 Page 16 An urgent requirement was made following the first two days of the inspection requiring the home to review the activities offered to service users to ensure their individual needs are met. A return visit to the home on 16th October showed evidence that the Registered Manager had responded to this by putting up a poster asking service users to contribute their ideas on activities they wanted to do. This has also been added to the home’s self-assessment review document by the Registered Manager to ensure that progress in meeting this requirement is monitored by the home itself. On the third day of the inspection it was noted that a trip to a local shopping centre had been organised for a group of service users. One service user spoken to reported that he had been asked if he wanted to go but had not been involved in making a choice as to which shopping centre he wanted to go to. A group of students from a local school were also at the home as part of their community service option playing a board game with one resident. The home has a fleet of vehicles that are wheelchair accessible and enable service users to access the community. It was noted that a minority of service users are able to access their community independently by motorised vehicles and as such, are able to get out and about as they wish both during the day and in the evenings. One service user who cannot access the community independently commented ‘if you tell your key worker that you wish to go to the shops then they will arrange a time to take you – it will usually be that same day or the next’. Discussion with another service user also indicated that he would talk to his key worker if he wanted to go out; ‘you have to arrange it at least 24 hours in advance’. Service users spoken with indicated that they were able to maintain contact with family and friends with the home welcoming visitors. All four relatives responding to comment cards indicated that they felt able to visit their relative in the home at any time although one relative commented that senior staff at the home did not always make the effort to greet them personally which they had found unwelcoming. Two of the four relatives responding to comment cards indicated that they felt they were kept informed of important matters affecting their relative but two indicated that they did not feel that they were kept informed or consulted on a regular basis. All service users have a key to their own rooms and are able to personalise their bedrooms as they wish. Leonard Cheshire has a Service Users’ National Association and the home has two Residents’ Representatives who can bring issues to the management meetings and ensure service users’ views are heard. The Registered Manager stated that service users are supported to be involved as they want to be in the running of their home, for example, the home has an allocated budget to enable residents to choose the food they want to eat for their evening meal and go with staff to purchase it. A hot water urn and microwave is accessible to service users who may wish to prepare a hot drink or snack for themselves. The Registered Manager talked of DS0000004006.V317714.R01.S.doc Version 5.2 Page 17 steps she has taken to promote service users’ independence including changing medication practices from a ‘medicine trolley’ to an individualised system by which the majority of service users store medication in their own rooms. The main meal at James Burns House is at lunch-time. There is a cook employed at the home who has responsibility for preparing breakfast and lunch each day for residents. There is a four-week cycle of lunch menu plans in place at the home, a copy of which had been pinned to a service users’ notice board. Discussion with service users indicated that on the day of inspection they had been given a choice of liver and bacon or pepper tart. This had been accompanied by courgettes and mange-tout. Service users spoken with commented that the lunch provided at the home was of very good quality. At inspection it was evident that the lunch choices on the day of inspection differed from that specified on the menu plan. A service user spoken with stated that they felt service users’ input into menu planning was limited although it was indicated by a Senior Team Leader that the cook is invited to attend Residents’ Meetings to promote service user involvement in the menu planning process. Service users spoken with indicated that they ‘always have sandwiches for tea’. Two service users spoken with stated that they wanted more variety at tea-time. The Registered Manager stated that service users could have variety and systems are in place to promote their involvement in planning tea-time menus if they so wish. However, it was acknowledged that uptake in this particular area had been limited. A residents’ survey on their satisfaction with the meals provided at the home was carried out in July 2006 and discussion with a Senior Team Leader indicated that this feedback was being used to make improvements in this area. Bowls of fresh fruit were available to service users on tables in the lounge. Bread, sandwich fillings, snack foods and drink-making facilities were also available in the kitchen areas adjacent to the lounges which were accessible to service users who wanted to prepare a drink or snack for themselves. The home’s self-assessment document indicates that service users are able to access the home’s main kitchen once the cook has left for the day. Meals are taken in the communal lounge areas of the home. One service user commented that it was difficult for him to access the table properly as his wheelchair did not fit under it. He stated that this made eating quite difficult for him. Records for one service user whose support plan states that he requires assistance with eating and drinking were reviewed. On three dates in the previous ten days only details about breakfast had been recorded with no entries for lunch or dinner on these days. Records for fluid input and output were also not fully completed. DS0000004006.V317714.R01.S.doc Version 5.2 Page 18 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Personal and health care support received by service users is generally of a good standard with service users’ health care needs met by liaison with the wider multi-disciplinary team. Shortfalls exist when there are inadequate numbers of staff on duty to meet service users’ personal care needs in a timely way and this must be addressed for the standard to be met. Procedures are in place to ensure that service users take their medication as prescribed and with due regard to their safety. EVIDENCE: Comments from service users about the personal are they receive were generally positive; ‘I m happy with all care received’; ‘Fantastic!’; ‘I can’t fault the personal care’; ‘I wouldn’t want to be anywhere else’. Members of staff spoken with demonstrated their awareness of the personal care needs of the service users they support and service users indicated feeling confident about staff’s competence in attending to their personal care needs including moving and handling. DS0000004006.V317714.R01.S.doc Version 5.2 Page 19 Shortfalls were identified in personal care provision on occasions where there were a lack of staff; ‘When we have sufficient staff everything is ok.’ One service user stated ‘If there is one phrase that would sum this place up it is “Can you wait a minute”’ as he described that staff are often rushing around and while they may acknowledge that he has called them by using his buzzer, they often ask him to wait as they are busy with another resident. He reported that this had resulted in him being left on his commode for forty minutes the previous evening after sounding his buzzer as staff had not been available to support him. He stated that on one occasion he had been left for one hour and twenty minutes. One relative stated in a comment card that they were disappointed in the lack of time for personal care and indicated that they did not feel there were always sufficient numbers of staff on duty. Another service user talked about the differences in the approach between staff when supporting him with his personal care needs. He identified that one member of staff did not support him with bathing in a sensitive way that met his preferences. In addition, the member of staff had left him alone in the bath which had made him feel unsafe. This issue was raised with the Senior Team Leader at the time of the inspection so that appropriate action could be taken to ensure better consistency of care between care staff and minimisation of risks for this service user. Service user plans showed that a multi-disciplinary approach has been used to ensure that service users’ health care needs are met. This includes input from General Practitioners, District Nurses, Nurse Specialists, Psychiatry and Physiotherapy. Two comment cards were received from general medical practitioners who have contact with service users at the home. Both indicated that the home communicates clearly and works in partnership with them and that staff demonstrate a clear understanding of the care needs of service users. For one service user who was admitted to the home with a pressure sore there was adequate information to show that this had been discussed with relevant professionals at admission and that a care plan had been put in place to address this including regular turning and District Nursing input. A ‘record of turning’ had been maintained with staff signing to indicate that the procedure had been carried out at an appropriate time. Documentation showed a significant improvement in the service user’s pressure sore. There was evidence that where a service user had been discharged from hospital a case conference had been held attended by the Hospital Discharge Co-ordinator, Social Services and representatives from James Burns House to ensure that the home was still an appropriate placement for him. Where a service user had required additional emotional support there was evidence that external support from a counsellor had been sought. DS0000004006.V317714.R01.S.doc Version 5.2 Page 20 Medication procedures at the home were reviewed in June 2006. The new procedure includes information on obtaining medicines, receipt of medicines, storage of medicines, administration, handling errors, providing medicines to service users during absences from the home, self-administration, disposal of medicines, record-keeping, non-prescription medicines, taking verbal orders and training. James Burns House uses a local pharmacy to provide medication for service users. The medication for the majority of service users is now stored in a lockable cupboard in service users’ rooms. The Registered Manager confirmed that risk assessments have been completed with regards to this. The medication for one service user was examined. Records, which are kept with the medication, indicated that medication had been given as prescribed. The service user concerned stated that she preferred the system of storing medication in her room as staff could give her medication at the same time as they attend to her personal care. The policy states that only members of staff who have received the relevant training are permitted to administer medication to service users. Training is accessed both in-house and through the local pharmacy. Training includes completion of a workbook and an assessment paper with a minimum of three observations at which point staff may be deemed competent. DS0000004006.V317714.R01.S.doc Version 5.2 Page 21 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Systems are in place within the home to ensure service users have opportunities to raise issues with staff and management but these are not always used to maximum benefit. Service users are protected from harm through implementation of policies and procedures and staff training that raises awareness of abuse. EVIDENCE: Leonard Cheshire has a complaints procedure and there was evidence of this procedure being on display in one of the corridors of the home. Residents’ meetings are held on a regular basis and two Residents’ Representatives have been appointed to act as liaison between service users and management to promote communication. Twelve of the eighteen service users responding to surveys indicated that they felt their care workers always listened and acted on what they said, with the remaining six service users that they usually or sometimes felt listened to. Twelve service users also indicated that they knew how to make a complaint. One of the service users spoken to reported that she had a good relationship with her key worker and felt that she would be able to talk with her key worker about any concerns. Another service user stated ‘I’d go to the boss’. Two of the four relatives returning comment cards indicated that they were not aware of the home’s complaints procedure. Complaints that are currently undergoing investigation were discussed with the Registered Manager. Discussion indicated that these were being investigated DS0000004006.V317714.R01.S.doc Version 5.2 Page 22 in line with the organisation’s procedure and information relating to the complaints and their outcomes was being kept on file. Training records indicate that all staff are introduced to the complaints and whistleblowing policies as part of their induction at the home. There is a procedure in place to protect service users from abuse. Abuse workshops are held on a regular basis for care workers and training records showed that staff attend workshops as part of their foundation training and are expected to attend update training every two years. The majority of staff have completed this training and those who have not were noted to have been booked onto training events in forthcoming months. Adult protection issues that have occurred since the last inspection of the service have been communicated to relevant agencies by the home in line with local procedures. DS0000004006.V317714.R01.S.doc Version 5.2 Page 23 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, 26 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A plan is in place to update the home’s external and internal environment and thus ensure that it is a pleasant place for residents to live. The level of wash basins in service users’ bedrooms do not allow full accessibility to wheelchair-users and therefore do not promote service users’ independence. The home has systems in place to ensure that it remains clean and that service users are protected from infection. EVIDENCE: James Burns House is a single-storey building and has level access for wheelchair users. The building has two communal lounges / dining areas for use by residents, a laundry room and shared toilets and bathrooms. All bedrooms have wash basins but discussion with service users indicated that DS0000004006.V317714.R01.S.doc Version 5.2 Page 24 they are unable to fit their wheelchairs under the basin area which means that they are unable to make effective use of them. The home employs a person who takes responsibility for maintenance of the building. Maintenance of the building is tracked in the home’s Self-Assessment Plan to ensure that a redecoration programme is implemented and individual rooms are maintained to an acceptable standard. Refurbishment of the building was recommended at the previous inspection of the service. It is clear from the home’s selfassessment tool that this is being given consideration and an action plan is in place to address any shortfalls. Service users are able to personalise their rooms as they prefer. Rooms are equipped with hoists and moving and handling aids to meet the service user’s individual requirements. The majority of service users responding to the survey indicated that the home is always fresh and clean. The home employs domestic staff for this purpose. James Burns House has an infection control policy. Service users spoken with confirmed that staff wear aprons and gloves when attending to their personal care needs. A sample of staff training records showed that staff are given infection control training at induction. DS0000004006.V317714.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Training for care workers within the home is comprehensive which means that service users can be confident that care workers can meet their personal care needs with competence. Recruitment procedures within the home are robust and this ensures that service users are protected by the people employed to work with them. EVIDENCE: The training records of a sample of care workers employed since the last inspection of the service show that all have attended a three day induction programme at the commencement of their employment which includes moving and handling training, infection control, disability and the law and complaints and whistleblowing. A range of other courses are also available to staff including training in Key Working, Individual Support Planning and Personal Relationships in addition to mandatory health and safety courses. A copy of the training calendar showed that training courses in these areas are organised at the home on a regular basis. The home has a dedicated Training and DS0000004006.V317714.R01.S.doc Version 5.2 Page 26 Development Officer whose responsibility it is to arrange and facilitate initial and update training for all staff. Team Leaders undertake further training that is specific to their roles and responsibilities. This was seen to include training in Staff Supervision, Managing Sickness Absence and Recruitment and Selection. Training records showed a good uptake of training in National Vocational Qualifications among the staff team. Of the 28 care workers’ records reviewed, ten were working towards their NVQ Level 2 qualification, thirteen had completed their NVQ Level 2 qualification and four care workers were qualified to NVQ Level 3 standard. Service users spoken with indicated that care workers were well-trained and were able to support them with confidence. The recruitment documentation for two care workers was reviewed. Both showed evidence of a PoVAFirst check and an enhanced disclosure with the Criminal Records Bureau. Both also showed evidence of two written references having been obtained prior to commencement of employment although one set of references provided a limited amount of information about the prospective worker (that is, dates of previous employment, job title, details of absence and disciplinary action and reason for leaving). It was suggested to the Registered Manager that in such cases more information should be obtained so that the individual’s suitability for the post can be properly determined. Both files showed adequate proof of the care worker’s identity and evidence of a structured interview process. DS0000004006.V317714.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff structure within the home offers clear lines of accountability and ensures that there is adequate leadership within the home for the benefit of staff and the service users they support. Quality assurance processes are in place to ensure that the service is monitored in terms of its success in meeting objectives and in offering a suitably safe and effective service for its residents. Systems to protect the safety and welfare of service users are in place by means of procedures, training and regular health and safety checks. DS0000004006.V317714.R01.S.doc Version 5.2 Page 28 EVIDENCE: The Registered Manager, Claire Hough, was appointed as the Service Manager for James Burns House in September 1999. She has since completed her NVQ Level 4 in Care and Registered Managers’ Award and has a range of other qualifications which show evidence of professional development including an NVQ Assessors’ and Verifiers’ Award, certification as a Moving and Handling Instructor and a Masters degree in Disability Studies. Mrs Hough is supported by a team that includes two Senior Team Leaders and three Team Leaders all of whom have delegated supervisory responsibilities for a team of approximately thirty-two Support Workers. Staff training within the home is organised by a Training and Development Officer. An Office Assistant is also in post to support the manager with general administrative responsibilities. Leonard Cheshire have a system by which homes assess themselves against set criteria. This self-assessment audit was started in February 2006 and comprises action planning and evaluation processes by which the home can measure its own success in meeting objectives. A copy of the self-assessment report, dated February 2006, was provided by the Registered Manager. Topics covered in the self-assessment process include independence and choice, privacy and dignity, equality and inclusion, monitoring quality, resource management, service users’ finances, the premises, records and administration and personnel issues. The report offers clear information about where the service is meeting objectives and where shortfalls exist with target dates set to address any outstanding issues. One of the Senior Team Leaders takes responsibility for internal quality assurance processes. There was evidence that a food satisfaction questionnaire was distributed to service users in July 2006 in order to gain feedback about the meals provided and to consult with service users about improvement. The Senior Team Leader stated that an audit to monitor implementation of individual key worker time for service users is also to be introduced. A sample of health and safety records was inspected. A fire risk assessment was written in October 2005 and the last visit by Dorset Fire and Rescue to the home was in September 2005. Fire training records were reviewed. A Senior Team Leader takes responsibility for co-ordinating staff training in fire awareness. All new staff are reported to have two one-hour sessions within the first ten days of employment at the home, this being confirmed by staff training records. A number of staff have been appointed as Fire Marshals and have undertaken specific fire marshal training within the organisation. This DS0000004006.V317714.R01.S.doc Version 5.2 Page 29 enables them to deliver fire training to other staff within the home following established session plans and scenarios. It was not clear from discussion whether a plan is in place to update training for designated Fire Marshals on a regular basis. Gaps in the fire training records of some night staff were identified. The Senior Team Leader reported that this had been due to there being no designated Fire Marshal on the night staff team. A Fire Marshal has now been appointed and will take responsibility for ensuring that all night staff have training at appropriate intervals. One member of night staff had been on sick leave when training had been delivered in August 2006. The Senior Team Leader reported that this would be addressed as a matter of urgency. It was also not clear from records whether staff are trained to use fire extinguishers and it was suggested to the Senior Team Leader that she liaise with the organisation’ s Regional Health and Safety Officer and Dorset Fire and Rescue with regards to this. Fire drills are carried out on a regular basis, the last one being in October 2006. Fire drill records show the date and time of the drill, the staff on duty, the time taken to evacuate the building and the outcome of the drill. It is recommended that the names of all service users participating in the drill are also recorded in the documentation. It is also recommended that fire drills take place at various times of day, in particular at times when staffing levels are reduced. The home’s fire alarm system is checked on a weekly basis by the person responsible for maintenance in the home. Leonard Cheshire has a Regional Health and Safety Officer with whom the home liaise on a regular basis. One of the Senior Team Leaders undertakes a structured health and safety check every three months, following which a report of her findings is sent to the Health and Safety Officer. The last threemonthly check was undertaken on 1st October 2006 and was seen to comprise an audit of accident reporting, moving and handling, doors and stores, fire safety, first aid, food safety, slips and trips, hazardous substances, infection control, maintenance, security, water systems and temperature checks. The Health and Safety Officer also undertakes an annual check of the premises and record-keeping within the home. A sample of staff training records indicated that care workers have attended training in food handling and hygiene, basic health and safety, infection control, moving and handling and emergency first aid. Where training updates were needed this had been identified in the record and entered on the training calendar. DS0000004006.V317714.R01.S.doc Version 5.2 Page 30 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 X 26 2 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 X 2 X LIFESTYLES Standard No Score 11 X 12 1 13 1 14 X 15 2 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 3 3 X 3 X 3 X X 2 X DS0000004006.V317714.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement The registered provider must ensure that the assessment of service users’ needs is kept under review. 1. YA6 14 The service user plan must be kept under review with the service user, involving significant professionals, family, friends and advocates as agreed with the service user. The provider must consult service users about the programme of activities arranged by or on behalf of the care home and provide facilities for recreation including, having regard to the needs of service users, activities in relation to recreation, fitness and training. The registered provider must consult with service users about their social interests and make arrangements to enable them to engage in local, social and community activities. The registered provider must ensure that records of the food provided for service users are in sufficient detail to enable any DS0000004006.V317714.R01.S.doc Timescale for action 31/10/06 2. YA12 16 31/10/06 3. YA13 16 31/10/06 4. YA17 17(2) 31/12/06 Version 5.2 Page 32 5. YA18 18 6. YA22 22 7. YA42 23 person inspecting the record to determine whether the diet is satisfactory, in relation to nutrition and otherwise, and of any special diets prepared for individual service users. The registered provider must ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. The registered provider must take appropriate action to ensure that all service users and their relatives / representatives know how to make a complaint about the service should they wish to. The registered provider must ensure that all care workers receive fire training at suitable intervals. 16/12/06 31/01/07 30/11/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard YA6 Good Practice Recommendations The registered provider should ensure that service user plans are better organised so that up-to-date information about the service user’s needs is at the front of the record and any ‘old’ information is appropriately archived. The registered provider should ensure that where service users are encouraged to make choices in relation to their personal care and set personal goals they are then supported to carry these out. This should be evidenced in the service user plan. The registered provider should ensure that risk assessments are dated and reviewed as necessary so that they contain up-to-date and relevant information about the service user’s needs. DS0000004006.V317714.R01.S.doc Version 5.2 Page 33 1. 2. YA7 3. YA9 4. YA15 5. YA26 6. YA42 The registered provider should consider ways in which the home can make positive links with the families and friends of service users and consult with them about issues affecting their relative / friend with the service user’s agreement. The registered provider should ensure that fittings in service users’ rooms, for example, wash basins, are designed to meet service users’ needs and are fully accessible to them. Fire drills should take place at variable times of the working day, including times when staffing levels are reduced. Records of fire drills should include the names of service users present in the home during the drill. DS0000004006.V317714.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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 DS0000004006.V317714.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!