CARE HOME ADULTS 18-65
King Street (57) 57 King Street Melksham Wiltshire BA14 9AE Lead Inspector
Malcolm Kippax Key Unannounced Inspection 8th March 2007 09:50 King Street (57) DS0000028382.V332924.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 King Street (57) DS0000028382.V332924.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. King Street (57) DS0000028382.V332924.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service King Street (57) Address 57 King Street Melksham Wiltshire BA14 9AE 01225 707669 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) ABLE (Action for a Better Life) Beverley Pollitt Care Home 6 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (6) of places King Street (57) DS0000028382.V332924.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 9th February 2006 Brief Description of the Service: 57 King Street is one of two care homes in Wiltshire that are run by the voluntary organisation ‘Action for a Better Life’ (ABLE). Knightstone Housing Association owns the property. 57 King Street provides care and accommodation for up to six people affected by mental illness. The home is situated within walking distance of Melksham town centre. The accommodation is on three floors. Each service user has their own room and there are three communal rooms. One of these is a dining room, which is also used as the home’s office. There is an enclosed garden and a parking area at the rear of the property. Service users receive support from the home’s manager and a permanent staff team of support workers. The fee level is £620 per week. Information about the service is available through a Statement of Purpose. King Street (57) DS0000028382.V332924.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection included an unannounced visit to the home on 8 March 2007 from 9.50 am - 4.00 pm. A second visit was arranged to complete the inspection and to give feedback. This took place on 15 March 2007 between 9.00 am and 11.30 am. Service users were spoken with and there were individual meetings with two support workers and with Ms Pollitt, the home’s manager. One service user was away from the home at the time of the visits. There was a tour of the home and a number of the home’s records were looked at. Other information and feedback about the home has been received and taken into account as part of this inspection: • • • The manager completed a pre-inspection questionnaire about the home. The service users completed surveys about their experience of the home. Comment cards were completed by two relatives and by a health care professional. The judgements contained in this report have been made from all the evidence gathered during the inspection, including the visits. What the service does well:
There is very good information recorded about the service users’ individual needs and interests. This helps to ensure that staff provide consistent support in the way that service users prefer. The care plans in particular are detailed and show a very personal approach to meeting each service user’s needs and wishes. For example, one service user is interested in astronomy and a need has been identified for them to be given time to talk about the stars with one of the staff team. Another care plan included support with self-esteem and the need to provide the service user with opportunities when they can feel important. Good risk assessments are being undertaken, which help service users to do the things they want to in a safe way, for example in the case of a service user who collects electrical equipment. Service users meet individually with staff members as part of the home’s key worker system and talk about their current situation. This is a good way in which the care plans can be updated to reflect changes in the service users’ needs or circumstances. It is also the opportunity for some ‘quality time’, as once a month the service user and their key worker have a meal together, usually outside the home. Service users are encouraged to be independent in areas such as managing their own money, household tasks and making decisions about how to spend their time. A service user said that one of the best things about living at 57
King Street (57) DS0000028382.V332924.R01.S.doc Version 5.2 Page 6 King Street was being close to the shops. Another service user had made a lot of contacts with local people and said that they went to a local church each week, which they could walk to. Service users spoke about things they had achieved, which included gaining certificates at evening classes and producing pictures at an art therapy class. Service users receive support from staff, which helps ensure that they keep in contact with family members and maintain relationships that are important to them. Comments received during the inspection from people outside the home were very positive. One person commented on how their relative in the home has been helped: ‘King Street is the best thing that has ever happened - it is their HOME and given confidence and security’. Service users have food that they enjoy and the mealtimes are flexible in order to meet their individual needs. The service users’ personal and healthcare needs are regularly reviewed. There is clear guidance for staff, so that they are aware of the areas in which service users can be independent and when they might need encouragement with personal care. Service users meet together at regular house meetings, which give them the opportunity to share any issues. They also receive information about how to express their concerns in a more formal way. Staff members receive guidance and training that helps to protect service users from harm. Service users like the location of the home. They have accommodation that meets their individual needs and provides a level of independence that they are happy with. There are systems in place which help to ensure that the home environment is safe for service users and staff. The support workers undertake training and qualifications, which means that the service users’ needs are met by competent staff. The home’s recruitment practices help to ensure that service users are protected from being supported by unsuitable staff. The home has a well qualified manager who is a good leader for the staff team and service users benefit from a well run home. Service users can express their individuality and have completed surveys in which they have been able to express their views about the home. What has improved since the last inspection?
The manager and staff team have looked in more detail at the meal arrangements and the type of food that service users have. As a result, information has been given to service users that will help them to make decisions about healthy eating and new meals that they might like to try. King Street (57) DS0000028382.V332924.R01.S.doc Version 5.2 Page 7 The arrangements for dealing with the service users’ medication have improved with a better system for ensuring that discontinued medication is returned promptly to the pharmacy. A new ‘Returns to Pharmacy’ sheet has been introduced, which shows that the medication has been appropriately dealt with when no longer needed. Staff training has continued; the most recent topic concerned mental capacity and changes in legislation. Knowledge in this area will help ensure that staff are up to date with some important developments affecting the rights of people to be able to make their own decisions. What they could do better:
Service users are generally well protected by the home’s medication procedures although there was found to be a lack of recording on one occasion. The circumstances for this need to be fully followed up to ensure that it is an exception and that a similar error does not arise, which could result in service users being at risk. The environment is generally very homely, although work is needed in some areas to ensure that service users live in well decorated and attractive surroundings. It would be beneficial for the organisation to look at the systems it has in place for redecorating the accommodation, to ensure that work is completed in a timely way. One part of the dining room is used as an office area and there were several notices and posters displayed on the walls and doors. This area would benefit from some reorganisation to ensure that the dining room looks as homely as possible. It was warm enough in the garden for service users to have their lunch outside at the time of one of the inspection visits. Garden furniture was available, although the wood was in need of cleaning up and varnishing, or being given another form of protection from the weather. Staff training in several areas was provided through the use of workbooks. It is recommended that other types of training are also considered in particular areas to ensure that staff benefit from as much outside expertise as possible. There were arrangements by which service users can pass on their views about the home but there was no policy on quality assurance to show how their views contribute to an annual development or improvement plan for the home. Ms Pollitt confirmed that she would be producing a new report on quality assurance, which would address this. King Street (57) DS0000028382.V332924.R01.S.doc Version 5.2 Page 8 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. King Street (57) DS0000028382.V332924.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 King Street (57) DS0000028382.V332924.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): These standards were not looked at on this occasion. EVIDENCE: The service users moved into 57 King Street over 20 years ago and there have been no changes in occupancy since then. The admission procedures have been assessed at recent inspections and Standards 1 and 2 were met when last looked at during the inspection in February 2006. King Street (57) DS0000028382.V332924.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 good. This judgement has been made using available evidence including the visit to the home. Service users benefit from the information that is recorded about their individual needs and interests. This helps ensure that staff provide consistent support in the way that service users prefer. Staff assist service users with making informed choices and respect their right to make decisions. Service users are supported to take risks as part of an independent lifestyle. EVIDENCE: Each service user had a care plan file that was regularly reviewed and updated. The plans covered a range of subjects, which were recorded separately on numbered forms. The files included a care plan index and review sheets, which meant that the contents were easily located and amendments to the plans were clearly shown. Service users had recorded their own comments on the review sheets.
King Street (57) DS0000028382.V332924.R01.S.doc Version 5.2 Page 12 The care plans focussed on the service users’ strengths and interests, as well as their personal needs or problems. Some subjects were covered in each care plan; others were more individual in nature. For example, one service user was interested in astronomy and a need had been identified for them to be given time to talk to staff about the stars. Another care plan included support with self-esteem and providing the service user with the opportunity to feel important. One section of the care plans included information about the intervention of staff and who was responsible. Staff members said that the care plans were informative. In the role of key worker, they had individual meetings with service users and amended the plans to reflect any changes in the service users’ needs or circumstances. Diaries were kept for each service user to record progress and daily events. Some topics in the care plans concerned the safety of service users when following a particular interest or choice of activity. Risk assessments had been highlighted in red on the care plans, for example concerning the use of electrical equipment in the case of one service user who was interested in obtaining different items and bringing them into the home. Other risk assessments had been undertaken in connection with smoking and hazards within the home. Staff encouraged service users to be independent in their day to day routines. Some service users received support with the safekeeping of their personal money and other people looked after their own. Records were kept of any transactions that involved money that was kept on behalf of service users. Service users had access to individual savings accounts. Service users were asked in the surveys if they made decisions about what they do each day. Four service users confirmed that they always did. Two people responded ‘usually’ and one person added the comment ‘Depending on what it is’. In response to another question, each service user confirmed that they could do what they want to do during the day, in the evening and at the weekend. In response to the question ‘Do the carers listen and act on what you say?’ three service users confirmed that this was always the case, two people stated that they usually did and one person that they sometimes did. Service users were able to collect their own post from the home’s front hall. A number of service users had their own mobile phones. A cordless phone was also available, which a service user said could be used without cost. King Street (57) DS0000028382.V332924.R01.S.doc Version 5.2 Page 13 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including the visits to the home. Service users can exercise independence in the home and have opportunities for personal development. They are part of the local community and benefit from support that helps to maintain relationships and develop individual skills. The service users’ rights and responsibilities are recognised within the daily routines. Service users have food they enjoy and mealtimes are flexible to meet their individual needs. EVIDENCE: Information about the service users’ activities and lifestyle choices was recorded in their care plans, which included sections such as ‘Independence’ ‘Getting up’, and ‘Social skills’. Individual needs had also been identified in areas such as improving literacy and money management.
King Street (57) DS0000028382.V332924.R01.S.doc Version 5.2 Page 14 Service users had different routines during the day. Two service users attended a workshop for four days a week. They said that they enjoyed the work and liked meeting up with other people. Another service user went to a garden centre for four days a week. Two service users had less regular occupation and made decisions on the day about what they wanted to do. The service users went out on an individual basis each month with their key workers, which included having a meal. One service user chose not to go out very often and Ms Pollitt described the ways in which this service user was supported with activities. The service user had a take away meal in the home with their key worker instead of the monthly meal out, which appeared to be a good alternative for this person. This service user’s care plan also included the need for them to have one to one time with staff with other activities. A service user said that one of the best things about living at 57 King Street was being close to the shops. They said that they could go out when they wished, but needed to tell a staff member or leave a note in a book that they were leaving the home. At the time of the visits, another service user went into the town centre on several occasions for different things. They said that they liked these frequent trips out and Ms Pollitt said that the service user had made a lot of contacts with local people. One service user said that they went to a local church each week, which they could walk to. The care plans included a section on ‘Family contacts’. During the visits some service users spoke about their relationships and the visits that they made. One service user said that they went on the bus once a week to visit family and returned by taxi, depending on how late it was. Another service user saw a close relative approximately every six weeks, with support from staff. In their comment cards, the relatives confirmed that they were welcome in the home at any time and could visit in private. They also felt that they were kept informed of important matters. Service users met together at house meetings about once a month. The meeting minutes showed a range of topics being discussed and service users had raised issues that they wanted to share with other people. At the March meeting, one person had said that they enjoyed going to ‘night school’. Some service users had gained certificates in subjects such as adult literacy and had put these up in their bedrooms. One service user attended an art therapy class and had painted pictures which were displayed on their bedroom walls. A food delivery was made to the home from a local supermarket during the visit on 8 March 2007. Staff members and service users made trips to the supermarket to choose the items, which were then delivered on a regular basis. Ms Pollitt said that for some months during the year the home also had a regular delivery as part of an organic vegetable box scheme. This was due to start again in June.
King Street (57) DS0000028382.V332924.R01.S.doc Version 5.2 Page 15 Service users said they chose the meals. Their choice was reflected in the weekly menu plans that were kept in the home. Healthy eating had been discussed at a recent staff meeting and staff had drawn up a list of different meals that service users might like to try and would add some more variety to the menu. This list was displayed in the dining room. People chose what they wanted they for lunch on 8 March and some service users and staff had this together in the garden. Service users had their main cooked meal together in the evening. The kitchen was used by service users for making their own drinks and snacks. King Street (57) DS0000028382.V332924.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is mainly good, although there was a shortcoming in the recording of medication. This judgement has been made using available evidence including the visits to the home. Personal and healthcare needs are regularly reviewed and service users benefit from the support that they receive. Service users are protected by the home’s medication procedures however there was a lack of recording on one occasion which was an exception to this. EVIDENCE: It was reported in the pre-inspection questionnaire that none of the service users required help with their physical care, although monitoring and encouragement were needed in certain areas. Each person had needs relating to their mental health. Staff members confirmed that their role was primarily to advise service users and encourage independence with personal care. In their surveys, both relatives confirmed that they were satisfied with the overall care that service users received. One person commented on how their relative in the home had been helped: ‘King Street is the best thing that has ever happened - it is their HOME and given confidence and security’.
King Street (57) DS0000028382.V332924.R01.S.doc Version 5.2 Page 17 The service users’ care plans included sections on physical care and medication, as well as some more specific issues such as fluid intake and skin care. There was guidance for staff about service users who would need advice or encouragement with their personal care. This included, for example a service user being able to cut their own nails, but being prompted by staff to soak their feet beforehand. Service users were registered with GPs at two local surgeries. There were well established arrangements by which service users received support from outside health professionals, including a Consultant Psychiatrist. A Community Psychiatric Nurse was in the role of Care Co-ordinator for all the service users. Ms Pollitt said that there were no concerns about the service users’ health at the current time and services were available when required. One service user had been referred for a hospital appointment and was waiting for an appointment date. Appointments and other health related information were recorded in the service users’ diaries. In their comment card, the health care professional confirmed that they were satisfied with the overall care provided to service users and were able to see service users in private. They also reported that medication was appropriately managed in the home and that any specialist advice they gave was incorporated into the service users’ plans. It was recommended at the last inspection that further attempts should be made to have service users’ medication prescribed locally, so that people could pick up their own prescriptions, which would further aid their independence. Ms Pollitt said that she continued to raise this with the relevant parties although there had been no new developments in this area. Each service user had a file that included a photo and a medication profile, which had been reviewed in January 2007. There was also guidance about the safe use of homely remedies. Medication was kept securely. Ms Pollitt confirmed that no controlled drugs or medication prescribed ‘as required’ were being administered at the time of the visits. Service users received support from staff with managing their medication, although there were ways in which service users were encouraged to take responsibility. One service user had a notice in their room, as a reminder of when they should be asking for their medication at different times of day. There was a requirement made at the last inspection that all discontinued medication must be returned to the pharmacy. A new ‘Returns to Pharmacy’ sheet had been produced in response to this, which included details of medication stock that had been taken back since the last inspection. There were records kept of the administration of medication. Record sheets were looked at. Overall, staff were consistently recording when medication was given, or not given for any reason, although a recent occasion had arisen
King Street (57) DS0000028382.V332924.R01.S.doc Version 5.2 Page 18 when this had not happened and the record was blank. This was brought to the attention of Ms Pollitt, who after an initial check was confident that the medication had been given as prescribed, but the staff member had not recorded this. The medication is kept in the dining room, which is also used as an office. This location meant that staff could possibly be distracted when dealing with medication. Staff members said that they had received training in the medication procedures. Training had been provided through a distance learning pack in the Safe handling of medication. Ms Pollitt said that she initially went through the procedures with new members of staff and assessed their competence during their period of induction. King Street (57) DS0000028382.V332924.R01.S.doc Version 5.2 Page 19 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 Quality in this outcome area is good. This judgement has been made using available evidence including the visits to the home. Service users are listened to and receive support that assists them to express their concerns. Staff members receive guidance and training that helps to protect service users from harm. EVIDENCE: Five service users confirmed in their surveys that they knew who to speak to if not happy with something and also how to make a complaint. One person did not confirm this. This could not be followed up with each service user as one person was staying away from the home at the time of the visits. Ms Pollitt said that she was confident that each service user had been given the information they needed and knew somebody who would help them with making a complaint if needed. A complaints procedure was displayed in the front hall and in the dining room. The home had not received any complaints during the last year and none have been made to the Commission during that that time. In their comment cards, both relatives confirmed that they had not needed to make a complaint, but they were aware of the home’s complaints procedure. The health care professional who completed a comment card confirmed that they had not received any complaints about the home.
King Street (57) DS0000028382.V332924.R01.S.doc Version 5.2 Page 20 The staff members who were spoken with were aware of various policies and procedures, including the organisation’s policy on whistle blowing. Staff members confirmed that they had received a copy of the ‘No Secrets’ booklet about reporting suspected abuse. Staff members had received in-house training about the prevention of abuse and the procedures for safeguarding adults. It was recommended to Ms Pollitt that staff would also benefit from some external input, for example through the involvement of a police officer from the Vulnerable Persons unit which is close to the home. All staff had Criminal Records Bureau (CRB) checks and new staff were checked against the Protection of Vulnerable Adults (POVA) register. King Street (57) DS0000028382.V332924.R01.S.doc Version 5.2 Page 21 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 and 30 Quality in this outcome area is mainly good, but poor in certain areas. This judgement has been made using available evidence including the visits to the home. Service users like the location of the home and have accommodation that meets their needs. The environment is generally homely, although work is needed in order to ensure that service users live in well decorated and attractive surroundings. EVIDENCE: 57 King Street has been converted from a large town house to provide residential care accommodation. The location of the home meant that service users could walk to a range of local amenities and shops that they liked to use. The accommodation looked homely and well personalised. Each service user had their own room. One service user had separate accommodation on the ground floor, which included their own bathroom and small hall area. Another service user said that they liked their attic style room on the second floor. The
King Street (57) DS0000028382.V332924.R01.S.doc Version 5.2 Page 22 communal space included two lounges and a separate dining room. These rooms were generally homely, with a co-ordinated approach to their décor and furnishing. One part of the dining room was used as an office area. The space was well arranged and furnished, but there were several notices and posters, which detracted from the homely appearance. Some of the notices were of interest to service users although others, such as an annual leave planner, related primarily to staff. Ms Pollitt acknowledged that the area would benefit from some reorganisation. Standards of decoration were varied in the domestic areas. Some areas were in need of attention and a date for their redecoration was agreed with Ms Pollitt. This included the kitchen, the bathroom on the ground floor and the shower room and toilet on the first floor. The door bolt in this toilet needed to be changed to a type of door lock that could be opened from the outside in the event of an emergency. There was an enclosed and sheltered garden at the rear of the property. It was warm enough during the visit on 8 March for some service users to spend time in the garden and to have lunch ‘al fresco’. The garden looked like a very good space for socialising and relaxation. Garden furniture was available, although this was in need of cleaning up and varnishing or other form of protection from the weather. In their surveys, five service users stated that the home was always fresh and clean. One person thought that this was sometimes the case. There were no unpleasant odours at the time of the visits. The accommodation was generally clean although the condition of the décor in some bathroom and toilet areas, as reported above, made it difficult to produce a clean and hygienic appearance. One of the lounges was designated as a smoking area. An extractor fan and air purifier had been installed to improve the atmosphere in this room. There was a kitchen and a separate laundry area, which reduced the risk of cross-infection. Infection control was included in the staff training programme and guidelines about good practice were displayed in the home. King Street (57) DS0000028382.V332924.R01.S.doc Version 5.2 Page 23 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 the visits to the home. Training and qualifications are undertaken, which help ensure that the service users’ needs are met by competent staff. Service users are protected from being supported by unsuitable staff. EVIDENCE: There was a staff team of six support workers, in addition to the home’s manager. Relief and agency staff were not being used. Three support workers had completed National Vocational Qualification (NVQ) at level 2 and another three people were working towards the qualification. In their surveys, the service users who commented stated that they were always treated well by staff. The relatives felt that, in their opinion, there were always sufficient numbers of staff on duty. The health professional who completed a comment card confirmed that there was always a senior member of staff to confer with and that staff demonstrated a clear understanding of the service users’ care needs.
King Street (57) DS0000028382.V332924.R01.S.doc Version 5.2 Page 24 Each support worker had a training file, which contained a chronological record of the training undertaken. Ms Pollitt had produced a training matrix, which showed a summary of training undertaken by the staff team. Training undertaken during the last year had included Care planning, Nutrition and Health, First Aid and a Mental Health Foundation course. There was also a training plan for 2007, which identified the training events that staff members were to attend during the year. This included ‘Enhanced Communication’, ‘Risk Assessment’ and ‘Coping with Aggression’, in addition to refresher courses in other subjects. All staff had recently attended a session about the new Mental Capacity Act. Ms Pollitt said there were about three staff meetings a month. One of these meetings each month was used as a training session. Training in several areas was provided through the use of workbooks for individual staff. There was discussion with Ms Pollitt about providing other opportunities for staff training in certain areas such as abuse awareness, as reported under standard 23. Training in first aid was covered using the workbooks, rather than through direct instruction by an approved person. A number of staff had first aid certificates. A staff member said that they had an induction fortnight when they had worked alongside another member of staff. They had had weekly meetings with the manager. Both staff members met with thought that they received good support and in-house training. Staff members had the opportunity to take an NVQ after successful completion of their probationary period. The employment records for two new staff members were looked at. A requirement about recruitment was made at the last inspection as not all the expected documentation was being kept on file. This had been addressed and there was evidence of a thorough recruitment process. Three people had interviewed and each had completed a form as a record of the interview and the applicants’ performance. Appropriate references and proof of the applicants’ identity had been obtained and kept on file. Applicants had completed a health questionnaire. Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks had been undertaken before the applicants had started work. King Street (57) DS0000028382.V332924.R01.S.doc Version 5.2 Page 25 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 the visits to the home. Service users benefit from a well run home. Service users are asked for their views about the home, although these could be more fully reflected in the home’s development plans. The health and safety of service users and staff are promoted and protected. EVIDENCE: Ms Pollitt was well qualified to manage the home, having completed the Registered Managers Award and achieved NVQ Level 4 in Care. During the last year Ms Pollitt has also gained the NVQ Assessor A1 award. Ms Pollitt attended some training events with the staff team and had also undertaken training King Street (57) DS0000028382.V332924.R01.S.doc Version 5.2 Page 26 specific to her role, including an accredited course in supervision and an ‘Effective appraisal’ course. Staff spoke positively about the support that they received. Relationships between service users, manager and staff were observed to be friendly and easy going. Ms Pollitt spoke respectfully about the service users and gave people the individual time that they needed, whilst also dealing with the management issues that arose during the inspection. The current service users had lived together for many years and had moved to 57 King Street in similar circumstances. Ms Pollitt said that there was the possibility that a change in occupancy would take place in the coming months. She was aware of the impact that this would have on service users and the need for compatibility between people who may have different backgrounds. Disability and equality was included as a subject in the staff training programme. Ms Pollitt did not feel that there were any significant diversity issues involving the current service users, although she confirmed that one service user had a cultural background that was different to others in the home. Ms Pollitt said that the service user expressed this part of their life as much as they wished to. The service user also spoke about this and was proudly wearing a cap that displayed a national emblem. The arrangements for quality assurance were discussed. One service user spoken with said that they had completed a questionnaire about their views of the home. Ms Pollitt confirmed that this was part of a survey to get feedback from service users, relatives and other interested parties. Records were seen, including the results of the survey and a report of the outcome. The people who responded had made some very positive comments about the home. Other means by which service users gave feedback were discussed with Ms Pollitt. This happened on a regular basis through the house meetings and key worker sessions, as well as on more informal occasions. Service users also attended meetings of the organisation’s Board of Trustees. There was no policy on quality assurance that referred to the different arrangements and how these contributed to an annual development or improvement plan for the home. Ms Pollitt confirmed that she would be producing a report on quality assurance, by the end of September 2007, which would meet the requirements of Regulation 24 of the Care Homes Regulations 2001. Ms Pollitt had provided information in the pre-inspection questionnaire about routine servicing and health and safety checks. These looked up to date, although Ms Pollitt was advised to check on whether a more recent electrical wiring certificate was required. This had last been issued in 1998. No serious accidents had arisen during the last year. Water temperatures were tested each week and all staff had received food hygiene training. Food temperatures were recorded on a daily basis.
King Street (57) DS0000028382.V332924.R01.S.doc Version 5.2 Page 27 A sample of health and safety related records were looked at in the home. A new fire risk assessment had been undertaken in August 2006 and the fire procedure reviewed in January 2007. Details of a fire drill on 21 February 2007 had been recorded in the home’s fire log book. It had been recommended at the last inspection that the time taken to evacuate the premises during a fire drill should be recorded. This was now happening. The fire alarms were being tested weekly. Two service users smoked and some safety measures were in place, as described in the care plans. The staff members met with were aware of the different arrangements that were being made in respect of the two service users. Staff members said that they felt safe working in the home and had people they could contact in the event of an emergency or when lone working at the weekends. An awareness of individual service users’ health and safety was evident in their care plans. For example, one plan referred to a service user and the risk of sunburn, with guidance about the need to use a high factor sun cream. The care plans also referred to the service users’ likely appearance and state of well-being if a problem arose when they were outside the home. King Street (57) DS0000028382.V332924.R01.S.doc Version 5.2 Page 28 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 N/A 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 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 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 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X King Street (57) DS0000028382.V332924.R01.S.doc Version 5.2 Page 29 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. 1. Standard YA20 Regulation 13(2) Requirement That staff initial or enter the appropriate code on each occasion when medication is administered to a service user. That the kitchen, shower room, bathroom and first floor toilet receive attention to ensure that they are in a good state of decoration. Timescale for action 09/03/07 2. YA24 23(2) 27/04/07 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 YA24 Good Practice Recommendations That the use of the dining room as an office area is reviewed to ensure that a homely environment is maintained as much as possible. That the condition of facilities in the kitchen is assessed and refurbishment is scheduled to ensure that the fitted units are maintained in a good condition.
DS0000028382.V332924.R01.S.doc Version 5.2 Page 30 2. YA24 King Street (57) 3. YA24 That the garden furniture is renewed or maintained to ensure that it is clean and in a good state of repair for use by service users and staff. That staff are given opportunities to increase their knowledge through the availability of a wider range of training methods. That a policy on quality assurance is produced, which sets out the ways in which the views of service users and others are sought and how these contribute to the home’s improvement plans. 4. YA35 5. YA39 King Street (57) DS0000028382.V332924.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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
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