Inspection on 29/07/08 for Lifestyles

This inspection was carried out on 29th July 2008.

CSCI found this care home to be providing an Adequate service.

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

Lifestyles 07/08/07

Lifestyles 19/07/06

Lifestyles 02/02/06

Lifestyles 07/06/05

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

Pennine Camphill

Muston Road (70)

Grayling

The Cornerstone

John Street Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOME ADULTS 18-65 Lifestyles 55-59 Wentworth Road Scarcroft Hill York YO24 1DG Lead Inspector Stevie Allerton Key Unannounced Inspection 29th July 2008 9:30am Lifestyles DS0000062824.V371798.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 Lifestyles DS0000062824.V371798.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. Lifestyles DS0000062824.V371798.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lifestyles Address 55-59 Wentworth Road Scarcroft Hill York YO24 1DG 01904 645650 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) Dove Care Ltd. Care Home 19 Category(ies) of Learning disability (19), Mental disorder, registration, with number excluding learning disability or dementia (19) of places Lifestyles DS0000062824.V371798.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th August 2007 Brief Description of the Service: Lifestyles is owned by Dove Care Limited and is registered to provide personal care, support and accommodation for up to 19 people with learning disabilities and mental disorder. Only men were being accommodated at the time of this inspection. The home comprises of three large terraced houses linked together with a variety of communal rooms, single and double bedrooms and a patio garden at the back of the house. The home is within walking distance of York city centre, its amenities and leisure facilities. The current weekly fee at the time of the site visit on 29th July 2008 is £419 per week and there are no additional charges, as the people living at the service purchase their own extras. Activities and holidays are included in the fees charged. Current information about services provided at Lifestyles is available in the form of a statement of purpose and service user guide that explains the care and services on offer at the home. The most recent inspection report is on display in the home. There is currently no registered manager, although an acting manager is in post. Lifestyles DS0000062824.V371798.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection was carried out without prior notification and was conducted by one inspector over the course of a day, from 9.30am to 6.00pm. Before the visit, accumulated information about the home was reviewed. This included looking at any notified incidents or accidents and other information passed to CSCI since the last inspection. The home also completed an Annual Quality Assurance Assessment (AQAA). All of this information was used to plan this inspection visit. Some staff surveys were left at the home, six of which were completed and returned. Their comments are included under the relevant outcome headings of the report. Seven relative surveys were also returned, along with a letter from a relative and a letter from one of the people living in the service, given to us during the day. Four people were case tracked, and other files and records were looked at. Case tracking is the method used to assess whether people who use services receive good quality care that meets their individual needs. Where appropriate, issues relating to the cultural and diverse needs of residents and staff were considered. Using this method, we looked at all twenty-one key standards from the Care Homes for Younger Adults National Minimum Standards, plus other standards relevant to the visit. We spent time with people living at the service and spoke to relevant members of the staff team who provide support to them. The acting manager was on duty throughout the day and feedback was given to her at the end of the visit. The registered providers were not present. What the service does well: The service provides support for people who do not readily fit in to other residential settings, and is careful about assessing the risk before offering people a place. People generally feel well supported. One person typed a letter to us, saying how he felt he had changed his life since moving here, and that it felt good, the staff were helping him and he felt he would be able to move on with his life. Lifestyles DS0000062824.V371798.R01.S.doc Version 5.2 Page 6 People who live at the service say they are happy with the level of activities and, generally, staff are aware of the need to support people to fulfil their leisure opportunities: “We encourage our residents to take part in the community as much as possible.” “We arrange outside activities and holidays away, supporting residents in all they do.” People are able to be involved in the running of their home, from helping with practical tasks to keeping the minutes of the house meetings. Some have achieved the Basic Food Hygiene certificate and are able to help with food preparation. Relatives are generally very positive, particularly about the changes in the home since the current owners took over: “The new owners have improved this care home. I have spoken with many of the residents, and in all cases have not had any bad reports from them. My son has far more freedom and is much happier with life.” “The home has a good atmosphere and I always feel happy when I call in”. “I feel the care service does well in all aspects. The new owners and staff have made a difference. They treat him as a human being. My son was very unhappy previously, but he is very happy now, they treat each resident individually.” “Without the support and care my son has had his life would not have the quality he has now. They have helped him enormously in the time hes been there. Im very grateful.” What has improved since the last inspection? Action had been taken to address requirements and recommendations from the last inspection. Changes had been made to care plans and there have been improvements made to the premises. Recruitment processes have improved, and all staff are now vetted properly prior to commencing employment. Staff supervision has also been started and staff had attended training days or made use of distance learning on specific topics. Relatives commented: “Lifestyles has had to adapt their service to suit my son’s needs, mostly this works well, but there are times when it breaks down -- this is an area which is still in the process of improving. My son and I have been a lot happier with the new regime brought to the home by Lifestyles - communication with them has improved. They are a lot better at responding quickly to any particular needs. My son is treated as an adult and responds well to this approach.” “The home is run at a higher standard than it was previously. My sons attitude and behaviour has improved. He sometimes brings one of the other residents out for the day to see me and by what they tell me they seem happier and more content.” Lifestyles DS0000062824.V371798.R01.S.doc Version 5.2 Page 7 What they could do better: Staff do not always have full access to peoples care plans and risk assessments, so they do not always know how to support people with particular areas of their life. This could lead to peoples needs not being met. The National Minimum Standards for Care Homes for Adults outlines in detail what is expected of care services and that the service user plan is key to achieving an individually appropriate lifestyle. Decisions taken at multidisciplinary meetings are not being reflected in peoples care plans; this means that staff are not up-to-date and have no written guidance on how to support people, through change, for example. One relative commented: “My son has mental health problems and is living alongside people with the majority having learning difficulties. I feel at times his needs are not being met. On visiting, I see apathy from some staff members, plus too much control from other staff members. I think things are improving slowly, but a lot more support is needed for individuals, plus more contact with family members. To improve, I think the food quality and cleaning of the home needs to improve.” The service assesses risk in many areas of peoples daily lives, but it is not clear what the staff are actually going to do to minimise the risks identified; lack of clear guidance to staff could mean either that people are put at risk, or their independence is restricted unnecessarily. There is a blurring of professional boundaries, which can lead to misunderstandings and resentment, if some people receiving the service perceive that others are being treated more favourably. Some staff members need guidance on how to record information in a more professional way in the records that are required by law. Records should always be dated and signed, including evaluations of care plans and risk assessments. Some parts of the premises needed attention, and were brought to the attention of the manager: • the seal of one of the fridges is perished and should be replaced. • the grout/sealant around the sink should also be replaced as it appears to be difficult to keep clean. • one of the fire exits was not able to be opened (it locks with a key, which was missing). Staff need to receive training in specific areas, such as Learning Disability and Autism, in order that they can properly support people with these assessed needs. Lifestyles DS0000062824.V371798.R01.S.doc Version 5.2 Page 8 As the registered providers have appointed an acting manager, who is in charge of the day-to-day running of the home (although not yet registered), they must carry out visits and make reports on the conduct of the home, so that we can be assured that all areas of operation are looked at and monitored. The purpose of our Annual Quality Assurance Assessment (AQAA) appears not to have been understood; it provided a minimum of information and was an opportunity missed for the registered provider to analyse and evaluate how well the service operates and set goals for the coming year. Requirements and recommendations for this service to improve are outlined at the end of this report. 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. Lifestyles DS0000062824.V371798.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 Lifestyles DS0000062824.V371798.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 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. There are appropriate levels of assessment in place prior to admission, also specific care plans for people referred from forensic services. This means that people are not offered a place unless the home feels they can meet their needs. EVIDENCE: Records and case files were looked at, along with the Statement of Purpose and Service User Guide. One of the people case-tracked was a relatively new admission. All of the expected assessment documentation and care plans were in place. One person spoken to said he was going to live at the owners’ new service in Derbyshire when it opens and said he was looking forward to it. Someone from another area was about to have a review, and there was evidence of his Care Manager being invited to attend. Lifestyles DS0000062824.V371798.R01.S.doc Version 5.2 Page 11 Equality & Diversity issues were explored with the manager. Apart from people with a quite varied range of mental health support needs, or support needs due to learning disabilities, there are also some people with visual impairments. There are care and support plans in place to minimise the effects of this. Lifestyles DS0000062824.V371798.R01.S.doc Version 5.2 Page 12 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 & 9 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The care plans and risk assessments that are in place are not able to be fully used by the staff, so they do not always know how to support people with particular areas of their life. This could lead to peoples needs not being met. The registered persons should be mindful that their actions in “rewarding” certain behaviour could blur professional boundaries. EVIDENCE: Four people were case tracked plus other files were looked at. The people selected had lived at the service for between 1 year and 24 years. Care and support plans showed who people’s named key worker was and some care plans had been signed by the person themselves, although there was no evidence seen in others that they had had any input into their own care plan. Lifestyles DS0000062824.V371798.R01.S.doc Version 5.2 Page 13 One care plan stated it had to be reviewed 1 -2 monthly. The assessment was done in June 2006 and the current care plan done in March 2008, with no evidence of review since then. The person’s risk assessment was difficult to understand, as more information is needed as to what staff are actually going to support people with. The risk assessment was not dated and did not appear to have been evaluated. There were general risk assessments for financial awareness, making hot drinks, holding a key and bathing safely. There was a support plan about activity, which had been updated by the manager but was not dated, so it was not clear when it would need to be reviewed again. Some care plans contained support plans about drinking alcohol; for example, someone goes out with the staff once a week for a drink, so that this is controlled and supervised. It was apparent from the files that some people are taken to the owners house once a week as a “reward” for behavioural issues. There is also the opportunity to do some jobs for the owners and earn some extra money for doing this. People confirmed that this was the case and that they enjoyed going, as it was a change of scene. Not everyone has the opportunity to take part in this, however, which may be a source of resentment. There were some issues highlighted in the daily records, which were raised with the manager, one to do with professional boundaries (an incident that had taken place at a staff members home), and another about the lack of professionalism shown in recording. Appropriate risk assessments were in place regarding slips, trips and falls, for someone who has a visual impairment, also regarding individuals who are vulnerable when out alone, perhaps because their behaviour has led to allegations being made about them in the past. There were notes of a discussion about a person planning on moving to Derbyshire, from a meeting at which his relatives and his care manager had been involved. It was not clear how staff would know how to support him through the transition, as there were no corresponding notes in his care plan to guide staff. People spoke to during the visit said that they were satisfied with the support they get at the service, and understood why there were some restrictions in things they could do, where relevant. One person typed a letter to us, saying how he felt he had changed his life since moving here, and that it felt good, the staff were helping him and he felt he would be able to move on with his life. Lifestyles DS0000062824.V371798.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 & 17 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People who live at the service say they are happy with the level of activities and, generally, staff are aware of the need to support residents to fulfil their leisure opportunities. Some people are involved in independent living arrangements, however, this could be developed further so that people can fulfil their potential to live more independently. The food in the home meets the dietary needs of people who use the service. EVIDENCE: We spoke to people at lunchtime about things to do in the local area. Peoples care plans identified the activities they enjoyed: swimming, walking, shopping, football, also helping around the house and kitchen. Some have passed their basic food hygiene course. Lifestyles DS0000062824.V371798.R01.S.doc Version 5.2 Page 15 One person said that he does all his own washing and ironing, confirmed by his activities plan, which also shows that he goes to bingo once a week with a fellow resident and his family. One gentleman goes to church. One person does voluntary work at York City Football Club. One person has his own snooker table in his bedroom, and also likes to go fishing. Some people are unable to go out without staff escorts, so may have to wait until sufficient staff are on duty before they can go out individually. Lunch was taken with residents and staff in the dining room, a hot snack, with evidence that people had a choice, e.g., some were having a sandwich. There was a good rapport between people, all sitting down together and there are some good friendships that have developed. Staff were discreetly helping a man with visual impairment who is also at risk of choking. His food had been roughly mashed up altogether, rather than blended as the manager said it should have been. She was advised to make sure that it was put in the care plan, that his food should be blended with separate components. A discussion took place later on in the kitchen to a man who was peeling potatoes ready for the evening meal. He does this most days, and enjoys helping. There was evidence that he understood food hygiene practices, as he was wearing protective apron and gloves and had his hair covered. Staff surveys included the following comments: “We encourage our residents to take part in the community as much as possible.” “We arrange outside activities and holidays away, supporting residents in all they do.” Lifestyles DS0000062824.V371798.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 & 20 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People have access to health care services within the local community, and there are proper arrangements for storing and administering medication, which ensures that people’s health and well-being is promoted. The restriction of information available to staff means that people may not always be supported in the best way that meets their individual needs. This has the effect that the service struggles to develop and implement newer ways of working with people, particularly those with mental health problems. EVIDENCE: There are people living at the home with diverse needs, with mental health problems as well as learning disabilities. The current age range of people living there is currently from 23 to 73. Lifestyles DS0000062824.V371798.R01.S.doc Version 5.2 Page 17 Staff do not have full access to the care plans; the manager says that they are informed on a “need to know” basis, because of the confidential information held in the care plans. We discussed ways in which this confidential information could be held securely elsewhere, so that staff have full access to care plans and know how to support people’s medical, personal, social and emotional needs at all times. There was evidence that changes in peoples physical health were picked up by the staff and appropriately referred for treatment. For example, someone was currently having treatment for a medical condition and there was good evidence in the daily notes about the action that staff took following the discovery of his condition, and that they sought medical attention swiftly. There was also evidence in peoples files of incidents that displayed a lack of professionalism when dealing with health and social care professionals (inappropriate recording). The service notifies us of incidents that affect people living at the home, some regularly repeated, which has given rise to the local police expressing concerns about how effective the support to individuals is. Medication procedures, storage and recording did not highlight any issues, although there was no proper risk assessment for someone self-medicating (eye drops) that showed how staff would monitor compliance with this. Lifestyles DS0000062824.V371798.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Knowledge about safeguarding adults and whistle-blowing procedures is limited, due to lack of current training. This can lead to inconsistent knowledge and practice and could mean that people using the service are not fully safeguarded. EVIDENCE: We looked at the complaints procedure, which was on display, but needed to be updated with the current CSCI contact details. People living at the service said they felt confident about telling the manager if they were not happy about something. A comment from a relative was also positive about the manager: “Carol, the manager, is always helpful and has always dealt with any concerns I have mentioned. I have found her to deal with my concerns very efficiently and immediately which gives me great confidence.” However, there is a suggestion from a former worker that whistleblowers are not taken seriously. The manager said that staff training is planned, on the Protection of Vulnerable Adults (POVA). Financial records were looked at with the home’s administrator: people are all funded by various local authorities. People contribute towards their fees each Lifestyles DS0000062824.V371798.R01.S.doc Version 5.2 Page 19 week from their income support, and those receiving Disability Living Allowance get a monthly payment straight into their savings. One person who was case-tracked draws his own income support and pays his fees in cash, but the administrator or the manager are appointees for other people. Records showed that people receive a personal allowance each week on Friday, signing to say their money was received. People buy their own toiletries, personal items and cigarettes. There are those who have help to budget their money; their records were looked at, showing how much is paid out, and how much goes into their savings. Lifestyles DS0000062824.V371798.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The ongoing programme of redecoration and renewal of furnishings is improving the environment for people living there. EVIDENCE: A tour of the communal areas was carried out, and one bedroom was seen by invitation of the occupant. Bathrooms and WCs were also seen. Parts of the home have been redecorated and upgraded, including the dining room, and one of the sitting rooms. There are two flats currently occupied for semi independent living, one for one person and one for two people sharing. One of the people who was case tracked has a cleaning timetable, which shows daily tasks around the house, including cleaning down the kitchen. Another person was spoken to in the kitchen as he was preparing potatoes for Lifestyles DS0000062824.V371798.R01.S.doc Version 5.2 Page 21 the evening meal. He also has a regular list of tasks, which he said he was happy with. He had cleaned a fridge that morning. There was evidence that he adhered to good hygiene practices, with protective apron, gloves, and his head covered. Some areas of the kitchen needed attention, and were brought to the attention of the manager: • the seal of one of the fridges is perished and should be replaced. • the grout/sealant around the sink, also should be replaced as it appears to be difficult to keep clean. The fire escape door at No 59 should be opened by key (which is not recommended by the Fire Safety Officer), but that key was missing. The manager agreed to take action straightaway to get this resolved, by fitting a push pad type of door closure, within two weeks. There was evidence that fire alarm tests are carried out weekly, and there are monthly drills with a good record of the responses to this. People who smoke do so in the designated area in the back garden. Lifestyles DS0000062824.V371798.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 & 36 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Recruitment processes meet requirements and staff have achieved a basic level of training. However, the staff team currently do not have the qualifications, training and support required to meet all of the assessed needs of the people living there, and there are no real plans in place to improve this. EVIDENCE: The information provided by the home in the AQAA stated that Criminal Records Bureau checks & references are obtained prior to staff starting work in the home and that full training is offered, leading to National Vocational Qualifications (NVQs). The information stated that more training has been given over the past 12 months, but there were no plans for further improvement in this outcome group. Lifestyles DS0000062824.V371798.R01.S.doc Version 5.2 Page 23 On site, staff files were looked at, along with working rotas and evidence of training. There are currently no volunteers working in the home. The manager had no knowledge of Skills for Care and the standards of training that they lead on. There was also no information about the General Social Care Council and their Code of Conduct for workers, or about the specific Learning Disability Induction Award (LDIA). The induction training package is provided through Learn Direct. Two members of staff had announced they were leaving; one new person had been recruited and had started induction training the week that the inspection took place. The manager said that staff supervision has commenced, and is planned for every two months at the minimum. Two night staff had had appraisals done. We discussed how to use supervision to develop the key worker role and evaluate the care plans. Staff spoken to during the inspection said that they had attended training days on Challenging Behaviour, Mental Health, First Aid, and Infection Control. Some were doing NVQ level 2 and one person doing NVQ level 3. Staff were also doing a distance learning course on the Mental Capacity Act. It was difficult to find written evidence that supported this and it was recommended that the manager put a training matrix in place, so that it could be seen who had attended what training and when they needed an update. Staff said that they did not have open access to care plans, and could only see sensitive confidential parts of the care plans on a “need to know” basis. One persons risk assessment stated that staff working with him should be trained in Autism, however, no staff have had Autism training. Staff records showed that written references, CRB checks and POVA first checks are carried out. The rotas showed that there are a minimum of 2 staff on each shift, 7:30 a.m. to 3:30 p.m., 2 p.m. to 10 p.m., and 10 p.m. to 7:30 a.m. The overlapping time between the early and late shift is frequently used to accompany people who wish to go out. There are no male support staff, except on night duty. Lifestyles DS0000062824.V371798.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 & 42 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Policies and procedures and practices that must be carried out by the registered person in order to meet regulations are all in place, to ensure that the service fulfils its stated purpose. However, the day-to-day running of this service would benefit by being led by people who can communicate a clear sense of direction and aspire to best practice and continuous improvement. EVIDENCE: The acting manager is currently studying for her Registered Managers Award and has two units remaining to complete. She had not yet applied to become Lifestyles DS0000062824.V371798.R01.S.doc Version 5.2 Page 25 registered with CSCI. The owners visit the home at least once a week, on a Thursday, when they take the residents back to their home. The manager says that she feeds back information to them during these visits, but there is no formal recording of which areas of the homes were inspected, or records of events looked at during the visits. The AQAA provided a minimum amount of information and was an opportunity missed. The purpose of the document was not fully understood by those completing it. There are systems in place for safe working, such as Health and Safety and Food Hygiene, although fire safety did throw up an issue with the locked fire door, and the key missing. People said that they have house meetings, fairly regularly. The person who keeps the minutes was spoken to. Quality surveys have been carried out with people living at the home. A sample of regulatory and operational records was seen during the day: care plans and daily records, accident records, residents financial records, menus, medication records, complaints records, maintenance records, fire safety records, staff files, staff training records, minutes of staff meetings, staff rotas, and policies and procedures. All were available for inspection, although not all were dated and signed. Lifestyles DS0000062824.V371798.R01.S.doc Version 5.2 Page 26 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 2 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 2 33 X 34 3 35 1 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 2 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 X 2 X 2 X 3 2 X Lifestyles DS0000062824.V371798.R01.S.doc Version 5.2 Page 27 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 YA6 Regulation 15 Requirement Care plans must be put in place that are usable documents for people and the staff supporting them. Staff must be able to have full access to the plans. They must contain detailed, agreed plans of how people are to be supported in all areas where a need has been identified through assessment. They must be reviewed regularly, updated where appropriate and dated and signed, so that staff always have the most up-to-date version in use. This is so that staff know what needs to be done to help people in various aspects of their lives. Risk assessments that identify an area for support must be linked to a specific support plan. This is so that staff know how to support someone in a way that neither exposes them to undue risk, nor takes away their Lifestyles DS0000062824.V371798.R01.S.doc Version 5.2 Page 28 Timescale for action 31/10/08 2 YA9 13(4)(b) 15 31/10/08 independence. 3 YA24 23(2)(b) Attention is needed to the following areas of the kitchen, identified during the inspection: • • A fridge seal is perished and needs to be replaced. The sealant around the kitchen sink needs to be replaced 31/10/08 4 YA24 23(4) This is so that the kitchen can be maintained in a clean and hygienic condition. The premises must meet the requirements of the local Fire Service, specifically with regard to the type of lock acceptable for an external fire exit. The fire exit at No 59 must be rectified as soon as possible. This is so that people are kept safe from the risk of fire. Staff must have the competencies and skills required to meet people’s needs. Specifically, staff must be trained and have knowledge of the particular conditions that people have, e.g., Mental Health problems, Learning Disabilities, Autism. They must also have the skills necessary to maintain professional relationships with GPs, Community Nurses, Social Workers, etc. This is so that people can be sure that they are supported by staff with the skills necessary for the tasks they are expected to do. 15/08/08 5 YA32 18(1)(c) 31/01/09 Lifestyles DS0000062824.V371798.R01.S.doc Version 5.2 Page 29 6 YA37 8 A Registered Manager needs to be put in place. 31/01/09 7 YA41 17 This is so that there is a line of accountability and the home runs smoothly and well. All records must be dated and 15/08/08 signed. This is so that accuracy can be maintained. The registered provider must make monthly reports on their visits to the home. These visits must include talking with people living in and working at the home, an inspection of the premises, and looking at records. This is so that they, as well as CSCI, can be assured that they are being kept informed about all aspects of the running of the home. 8 RQN 26 31/10/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA6 Good Practice Recommendations Important decisions reached that lead to changes in people’s lives, for example, as a result of a multidisciplinary review, should be translated into appropriate support plans, outlining how the staff are to provide support through the change. This is so that staff are fully aware of what support people may need and can reassure, or help with practical planning, appropriately. Risk assessments should be signed by people using the service to indicate that they are in agreement with any actions that are being taken that may place restrictions on DS0000062824.V371798.R01.S.doc Version 5.2 Page 30 2 YA9 Lifestyles them. This shows how people have been involved in making decisions about their support. If people need particular help with how meals are presented, i.e., blended foods, then this should be outlined in the specific part of their care plan. This is so that all staff know how someone’s food is to be presented and minimise the person’s risk of choking. The complaints procedure should be updated so that it reflects the current contact details for CSCI. This is so that people know who to contact if they do not want to approach the home directly. All of the staff team, along with the registered providers, should have up-to-date training in Adult Protection and the home’s Whistle Blowing procedure. This is so that everyone is aware of safeguarding people from potential abuse and can respond appropriately if such suspicions arise. There should be a training and development plan in place, so that staff have a structured programme of induction and on-going training. This is so that the registered persons can be sure that all staff have received the appropriate training for their role and can monitor and plan for when updates are needed. The manager should receive training and support regarding the role of supervision. This is so that staff receive the right support and supervision they need to carry out their jobs. Staff should receive guidance and supervision in how to keep records that are required by law. This is so that records are professional and accurate, based on fact and not on personal opinion. 3 YA17 4 YA22 5 YA23 6 YA35 7 YA36 8 YA41 Lifestyles DS0000062824.V371798.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Lifestyles DS0000062824.V371798.R01.S.doc Version 5.2 Page 32 Lifestyles DS0000062824.V371798.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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