Inspection on 10/08/04 for Little Arches

Care Homes For Adults (18 ­ 65)Little Arches83 Cambridge Street Clifton Rotherham South Yorkshire S65 2STAnnounced Inspection10th August 2004 Commission for Social Care InspectionLaunched in April 2004, the Commission for Social Care Inspection (CSCI) is the single inspectorate for social care in England. The Commission combines the work formerly done by the Social Services Inspectorate (SSI), the SSI/Audit Commission Joint Review Team and the National Care Standards Commission. The role of CSCI is to: · Promote improvement in social care · Inspect all social care - for adults and children - in the public, private and voluntary sectors · Publish annual reports to Parliament on the performance of social care and on the state of the social care market · Inspect and assess `Value for Money of council social services · Hold performance statistics on social care · Publish the `star ratings for council social services · Register and inspect services against national standards · Host the Childrens Rights Director role.Inspection Methods & FindingsSECTION B of this report summarises key findings and evidence from this inspection. The following 4-point scale is used to indicate the extent to which standards have been met or not met by placing the assessed level alongside the phrase Standard met? The 4-point scale ranges from: 4 - Standard Exceeded (Commendable) 3 - Standard Met (No Shortfalls) 2 - Standard Almost Met (Minor Shortfalls) 1 - Standard Not Met (Major Shortfalls) O or blank in the Standard met? box denotes standard not assessed on this occasion. 9 in the Standard met? box denotes standard not applicable. X is used where a percentage value or numerical value is not applicable. ESTABLISHMENT INFORMATION Name of establishment Little Arches Address 83 Cambridge Street, Clifton, Rotherham, South Yorkshire, S65 2ST Email address Tel No: 01709 517461 Fax No:Name of registered provider(s)/company (if applicable) Mrs Andrea Briggs Mr. David Lambert Name of registered manager (if applicable) Mrs Andrea Briggs Type of registration Care Home No. of places registered (if applicable) 4Category(ies) of registration, with (number of places) Learning disability (4) Registration number C070000092 Date first registered 30th July 2002 Was the home registered under the Registered Homes Act 1984 as amended? Do additional conditions of registration apply ? Date of last inspectionDate of latest registration certificate 5th May 2004 yes NO 13/01/2004 If Yes refer to Part CLittle ArchesPage 1 Date of inspection visit Time of inspection visit Name of inspector Name of inspector Name of inspector 1 2 310th August 2004 12:00 pm Peter BurkinshawID Code074229Name of inspector 4 Name of specialist (e.g. Interpreter/Signer) (if applicable) Name of establishment representative at the time of inspectionLittle ArchesPage 2 CONTENTSIntroduction to Report and Inspection Inspection Visits Brief Description of the Services Provided Part A: Summary of Inspection Findings Inspectors Summary Statutory Requirements/Good Practice Recommendations from last Inspection Conditions of Registration Statutory Requirements/ Good Practice Recommendations from this Inspection Part B: Inspection Methods & Findings National Minimum Standards for Care Homes for Adults (18 ­ 65) 1. Choice of Home 2. Individual Needs and Choices 3. Lifestyle 4. Personal and Healthcare support 5. Concerns, Complaints and Protection 6. Environment 7. Staffing 8. Conduct and Management of the Home Part C: Part D: D.1. D.2. D.3. Compliance with Conditions ( if applicable) Providers Response Providers Comments Action Plan Providers AgreementLittle ArchesPage 3 INTRODUCTION TO REPORT AND INSPECTION Every establishment that falls within the jurisdiction of the Commission for Social Care Inspection (CSCI) is subject to inspection, to establish if the establishment is meeting the National Minimum Standards relevant to that setting and the requirements of the Care Standards Act 2000 as amended. This document summarises the inspection findings of the CSCI in respect of Little Arches. The inspection findings relate to the National Minimum Standards (NMS) for Care Homes for Adults (18-65) published by the Secretary of State under the Care Standards Act 2000. The Regulations applicable to the inspected service are secondary legislation, with which a service provider must comply. Service providers are expected to comply fully with the National Minimum Standards. The National Minimum Standards will form the basis for judgements by the CSCI regarding registration, the imposition and variation of registration conditions and any enforcement action. The report follows the format of the NMS and the numbering shown in the report corresponds to that of the Standards. The report will show the following: · Inspection methods used · Key findings and evidence · Overall ratings in relation to the standards · Compliance with the Regulations · Required actions on the part of the provider · Recommended good practice · Summary of the findings · Providers response and proposed action plan to address findings This report is a public document. INSPECTION VISITS Inspections are undertaken in line with the agreed regulatory framework with additional visits as required. This is in accordance with the provisions of the Care Standards Act 2000. The following inspection methods have been used in the production of this report. The report is based on the findings of the specified inspection dates.Little ArchesPage 4 BRIEF DESCRIPTION OF THE SERVICES PROVIDED. Little Arches is a 4-bedded unit for adults with learning disabilities; it is owned and operated by Mrs Andrea Briggs who is both the registered person and manager. A small staff team of four enables Little Arches to provide a homely approach to care enhanced by the small size of the group and the ratio of one member of staff to service users at all times. This ratio increases on occasion such as reviews, trips, appointments etc. The building is a detached property close to Rotherham town centre and service users all have private accommodation for use as bedrooms and share the rest of the house that includes a dining room, large lounge, conservatory, patio and garden. Users participate in the daily routine of the home including shopping, cooking and cleaning.Little ArchesPage 5 PART ASUMMARY OF INSPECTION FINDINGSInspectors Summary (This is an overview of the inspectors findings, which includes good practice, quality issues, areas to be addressed or developed and any other concerns.) This inspection took place on the afternoon of the 10th August 2004. Since the last inspection in January 2004 the Registered Provider has added one further place at Little Arches by converting a former garage into a self-contained single bedded unit. Prior to the opening of this annexe the building and the proposed care arrangements were the subject of a successful `Variation to Registration application to the Commission for Social Care Inspection. This annexe to Little Arches is called `The Cottage and is occupied by a service user who was referred to the home in July and moved in following a series of introductory visits. The Inspector found that three of the four service users currently accommodated at Little Arches are all appropriately placed but a fourth service user is planned to move to another placement as her assessed needs cannot be met at Little Arches. Choice of home (Standards 1-5) All of these National Minimum Standards were met in full. Prior to admission full assessments are undertaken by the registered manager of Little Arches. Each service user is provided with a contract and introductory visits take place. Individual Needs and Choices (Standards 6-10) National Minimum Standards 7,8 and 10 were inspected during this visit and all were met in full. Little Arches is a small group home with a maximum of four service users living there at one time. All service users are able to communicate and are consulted regularly both on an individual and group basis with regard to their satisfaction about daily life at the home. Any reason to restrict a service users rights are recorded on their personal file. Lifestyle (Standards 11-17) All of these National Minimum Standards except National Minimum Standard 15 were inspected during this visit and were met in full All service users maintain contact with family, friends and persons they have known in work and training settings by choice. In all cases Little Arches welcomes and facilitates this contact by telephone, letter or personal visit including welcoming visitors to the home. Meals are a regular item of discussion and users are encouraged to state their preferences and follow through by shopping for them and preparing them in the kitchen at Little Arches. Individual likes and dislikes are catered for and the meals are eaten in the dining area or in the loungeLittle ArchesPage 6 Personal and Healthcare Support (Standards 18-21) All National Minimum Standards except National Minimum Standard 20 were inspected on this visit and were met in full. All service users are registered with a General Practitioner and are able to attend the health centre if necessary. Staff accompany on these occasions. Where other agencies are involved in the health care of service users the staff at Little Arches work closely with them. Concerns, Complaints and Protection (Standards 22-23) Both of these standards were met Each service user is provided with a copy of the homes complaints procedure, although it is in written form it also uses the `smiley faces pictures to explain the concept of happy or unhappy to the users and assist them in understanding the purpose of the procedure. Relatives are also provided with a copy of the complaints procedure and are positively encouraged to bring any concerns to the attention of staff. One service user has been referred to their placing authority Adult Abuse section following a deterioration in their behaviour towards staff and other service users. Environment (Standards 24-30) All National Minimum Standards were inspected during this visit and all were met in full The home is well maintained, the décor is good and the fixtures and fittings are to a good standard. Staffing (Standards 31-36) All National Minimum Standards were inspected during this visit and all were met in full The home is able to maintain the staffing levels as per their statement of purpose and function. The home has a training strategy linked to Doncaster College and already meets the 50 trained members of care staff with NVQ Level 2 or equivalent by 2005 standard. Two staff commenced NVQ level 2 training in March. Management and Administration (Standards 37-43) All National Minimum Standards were inspected during this visit; National Minimum Standards 37 and 43 were not met in full The registered manager works with a stable staff team of carers. Mrs Briggs is currently studying to acquire the NVQ level 4 in Management qualificationLittle ArchesPage 7 Requirements from last Inspection visit fully actioned? If No please list belowYESSTATUTORY REQUIREMENTS Identified below are areas not addressed from the last inspection report which indicate a non-compliance with the Care Standards Act 2000 and accompanying Regulations. The code in Standard is a cross-reference to the Standards described in full in the section Inspection Findings. No. Regulation Standard Required actions Timescale for actionAction is being taken by the Commission for Social Care Inspection to ensure compliance in regard to the above requirements. RECOMMENDATIONS Identified below are recommendations from the last inspection that have not been implemented No. Refer to Good Practice Recommendations StandardCONDITIONS OF REGISTRATION THAT APPLY (OTHER THAN NUMBERS AND CATEGORY OF SERVICE USERS).MET (YES/NO)Little ArchesPage 8 STATUTORY REQUIREMENTS IDENTIFIED DURING THE INSPECTION Action Plan: The Registered Person is requested to provide the Commission with an Action Plan, which indicates how requirements are to be addressed with the time scale within which such actions will be taken. This action plan will be made available on request to the Area Office.STATUTORY REQUIREMENTS Identified below are areas addressed in the main body of the report which indicate noncompliance with the Care Standards Act 2000, and accompanying Regulations 2001, and the National Minimum Standards. The Registered Provider(s) is/are required to comply within the given time scales. The code in Standard is a cross-reference to the Standards described in full in the section Inspection Findings. No. Regulation Standard * Requirement Timescale for action 1 25 YA43 The Registered Provider must send the Inspector a copy of her annual business statement as provided by her accountant to confirm that the business is financially viable 30/09/2004RECOMMENDATIONS Identified below are areas addressed in the main body of the report which relate to National Minimum Standards and are seen as good practice issues which should be considered for implementation by the registered Provider(s). The code in Standard is a cross-reference to the Standards described in full in the section Inspection Findings. No. Refer to Good Practice Recommendations Standard * 1 YA37 The registered manager should acquire the NVQ level 4 Management qualification requirement by 2005* Note: You may refer to the relevant standard in the remainder of the report by omitting the 2-letter prefix e.g. YA10 refers to Standard 10.PART BINSPECTION METHODS & FINDINGSThe following inspection methods have been used in the production of this report Little Arches Page 9 Direct observation Indirect observation Sampling · Pre-inspection questionnaire · Records · Care plans / Care pathways · Meals · Activities · Other enter details here `Tracking care and support Group discussion with service users Individual discussion with service users Group discussion with staff Individual discussion with staff Discussion with management Service user survey Relatives/significant others survey/feedback Visiting professionals survey / feedback Tour of premises Formal interviews Document reading Additional inspection information: Number of service users spoken to at time of inspection Number of relatives/significant others the inspectors had contact with Number of letters received in respect of the service CRB check for the responsible individual seen CRB check for the manager seen Certificate of registration was displayed at the time of the inspection Certificate of registration accurately reflected the situation in the service at the time of inspection Total No. of care staff employed (excluding managers) Total No. of staff with nursing qualifications employed Date of inspection Time of inspection Duration of inspection (hrs)YES YES YES YES YES YES YES NO YES YES YES YES YES YES YES YES YES YES YES YES 3 1 4 YES YES YES YES 4 0 10/08/04 12:00 4.0The following pages summarise the key findings and evidence from this inspection, together with the CSCI assessment of the extent to which the National Minimum Standards for Adults (18-65) have been met. The following scale is used to indicate the extent to which standards have been met or not met by placing the assessed level alongside the phrase Standard met? Little Arches Page 10 The scale ranges from: 4 - Standard Exceeded 3 - Standard Met 2 - Standard Almost Met 1 - Standard Not Met (Commendable) (No Shortfalls) (Minor Shortfalls) (Major Shortfalls)0 or blank in the Standard met? box denotes standard not assessed on this occasion. 9 in the Standard met? box denotes standard not applicable. X is used where a percentage value or numerical value is not applicable.Little ArchesPage 11 Choice of HomeThe intended outcomes for the following set of standards are: · · · · · Prospective service users have the information they need to make an informed choice about where to live. Prospective service users individual aspirations and needs are assessed. Prospective service users know that the home they 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.Standard 1 (1.1 ­ 1.4) The registered person produces an up to date statement of purpose setting out the aims, objectives and philosophy of the home, its services and facilities and terms and conditions; and provides each service user with a service users guide to the home. The statement of purpose should clearly set out the physical environmental standards met by the home in relation to standards 24.2, 24.9, 25.3, 25.5, 27.2, 27.4 and 28.2; and a summary of this information should appear in the service users guide. 657 657 Range of fees charged From To £ £ (per week) YES Any charges for extras If yes, please state what the extras are Key findings/Evidence Toiletries and contributions towards holidays 3 Standard met?Each service user has a tenancy agreement that contains full details of the services provided at Little Arches including the support and facilities available for the service user and the room allocated to them.Standard 2 (2.1 ­ 2.8) New service users are admitted only on the basis of a full assessment undertaken by people competent to do so, involving the prospective service user, using an appropriate communication method and with an independent advocate as appropriate. 3 Key findings/Evidence Standard met? The Registered Provider /Registered Manager, Andrea Briggs, works In liaison with other agencies, e.g. social workers, occupational therapists, physiotherapists, community psychiatric nurses, community adult learning disabilities team and others prior to the admission of any service user. She visits the prospective user in the community and preadmission visits to Little Arches take place involving the service user, their family and anyone else with a responsibility for their care. The Inspector saw evidence of this process taking place prior to the recent admission of the fourth service user to `The Cottage annexe.Little ArchesPage 12 Standard 3 (3.1 - 3.10) The registered person can demonstrate the homes capacity to meet the assessed needs (including specialist needs) of individuals admitted to the home. 3 Key findings/Evidence Standard met? The current resident group at Little Arches comprises of four service users all with assessed needs relating to learning disability. Their needs are met in full by a staff group organised and trained to provide care to the individual requirements of each resident. The homes statement of purpose and function also gives details of the specific needs met at the home. In the case of one service user a gradual deterioration in their health and behaviour has led to a re-assessment of need and it is agreed that a more appropriate placement is found. This process has involved the service user throughout and has included other agencies in a planned departure aimed at achieving a smooth transfer to a new placement. Standard 4 (4.1 - 4.5) The registered manager invites prospective service users to visit the home on an introductory basis before making a decision to move there, and unplanned admissions are avoided wherever possible. 3 Key findings/Evidence Standard met? All current service users were invited to visit Little Arches prior to taking up permanent tenancy. All admissions were planned and the home is currently full. Emergency admissions do not take place.Standard 5 (5.1 - 5.5) The registered manager develops and agrees with each prospective service user a written and costed contract/statement of terms and conditions between the home and the service user. 3 Key findings/Evidence Standard met? Each service user is represented by a placing authority that agrees the contract and the terms and conditions of occupancy at Little Arches prior to admission.Little ArchesPage 13 Individual Needs and ChoicesThe intended outcomes for the following set of standards are: · · · · · 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.Standard 6 (6.1 ­ 6.10) The registered manager develops and agrees with each service user an individual Plan which may include treatment and rehabilitation, describing the services and facilities to be provided by the home, and how these services will meet current and changing needs and aspirations and achieve goals. 0 Key findings/Evidence Standard met? Not assessed on this inspectionStandard 7 (7.1 ­ 7.7) Staff respect service users right to make decisions, and that right is limited only through the assessment process, involving the service user, and as recorded in the individual Service User Plan. 3 Key findings/Evidence Standard met? Any reason that restricts a service users right to make a decision is recorded in their personal profile. Daily choices of activities and routines are listed in individual programme plans and profiles and these are illustrated in social and day-care timetables. Personal control of monies is not possible with the reasons why stated in the personal profile. Finance policy protects service user interests by including records kept of all incoming and outgoing payments with receipts obtained for outgoing expenditures and monies safely secured on site. Little Arches practice is to ensure that service users have at least £1 on their person when they go to day care, this is seen as `pocket money spent by the service user to purchase drinks, snacks, sweets etc. acting independently of staff and no receipts are required.Little ArchesPage 14 Standard 8 (8.1 ­ 8.5) The registered manager ensures that service users are offered opportunities to participate in the day to day running of the home and to contribute to the development and review of policies, procedures and services. 3 Key findings/Evidence Standard met? Little Arches is a small group home with a maximum of four service users living there at one time. This setting promotes the opportunity to involve service users in the day-to-day running of the home and this is done by inviting them to participate in the domestic routines of keeping a home plus shopping for food and deciding on menus. Service users are consulted regular both on an individual and group basis with regard to their satisfaction about daily life at the home. All four are able to communicate via speech what they would like to see happening in their lives and at Little Arches. Standard 9 (9.1 ­ 9.4) Staff enable service users to take responsible risks, ensuring they have good information on which to base decisions, within the context of the service users individual Plan and of the homes risk assessment and risk management strategies. 0 Key findings/Evidence Standard met? Not assessed on this inspectionStandard 10 (10.1 ­ 10.6). Staff respect information given by service users in confidence, and handle information about service users in accordance with the homes written policies and procedures and the Data Protection Act 1998, and in the best interests of the service user. 3 Key findings/Evidence Standard met? Staff are sensitive to the information relating to the personal histories of all of the service users and ensure that this information is kept secure and not discussed in any detail in front of others. Service users correspondence, their telephone calls and discussions about individuals at staff handover times are all carried out in private. Records are stored safely and securely and staff are aware of the need for confidentiality through their induction training and the homes policies and proceduresLittle ArchesPage 15 LifestyleThe intended outcomes for the following set of standards are: · · · · · · · 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.Standard 11 (11.1 ­ 11.4) Staff enable service users to have opportunities to maintain and develop social, emotional, communication and independent living skills. 3 Key findings/Evidence Standard met? All service users are encouraged to participate in the daily routine of living in a homely environment, each user is encouraged and enabled through staff assistance to clean their private accommodation and carry out personal laundry tasks including ironing. Other daily living skills are promoted by involvement in baking, sewing and gardening as well as deciding the daily menu, shopping for the menu items and then preparing them in the kitchen. Users regularly visit or use local amenities such as the neighbourhood corner shop, and the local pub. Away from Little Arches they socialise with old friends and meet new people through Gateway Club, and attendance at local college. Both old and new friends are welcome to visit at Little Arches, share a meal and mark special occasions Standard 12 (12.1 ­ 12.6) Staff help service users to find and keep appropriate jobs, continue their education or training, and / or take part in valued and fulfilling activities. 3 Key findings/Evidence Standard met? Away from Little Arches each service user takes part in a valued activity. One service user attends day centre three days a week; another goes gardening, attends day centre and is involved with the local church involvement including serving refreshments on Saturdays, she is in contact with Pathways regarding further employment. A third attends college Tuesday and Thursday and healthy hearts on Friday. The most recent arrival is still establishing what she wants to do; she currently swims weekly and goes to the library and church. Personal skills learned through involvement in shopping, baking, painting and day trips are all organised by staff at Little Arches.Little ArchesPage 16 Standard 13 (13.1 ­ 13.5) Staff support service users to become part of, and participate in, the local community in accordance with assessed needs and the individual Plans. 3 Key findings/Evidence Standard met? Opportunities of this nature are provided on a choice basis with users going either individually or collectively to the local pub, local church fetes, parks, and using the local shop. Service users go to the local shop independently after being seen safely across the road.Standard 14 (14.1 ­ 14.6) Staff ensure that service users have access to, and choose from a range of, appropriate leisure activities. Key findings/Evidence Standard met?3In addition to the organised structured activities relating to employment and education, service users also go swimming, dancing and attend the cinema. Day trips provide another form of leisure activity. Holidays are also organised with a trip planned for two service users to Skegness in August, another is going to the Lake District with Mencap with another enjoying daytrips instead of a week away. Users contribute towards the cost of the holiday depending on the overall cost. Standard 15 (15.1 ­ 15.5) Staff support service users to maintain family links and friendships inside and outside the home, subject to restrictions agreed in the individual Plan and Contract (subject to standards 2 and 6 if necessary). 0 Key findings/Evidence Standard met? Not assessed on this inspectionLittle ArchesPage 17 Standard 16 (16.1 ­ 16.11) The daily routines and house rules promote independence, individual choice and freedom of movement, subject to restrictions agreed in the individual Plan and Contract (subject to Standards 2 and 6 if necessary). 3 Key findings/Evidence Standard met? Daily routines around the house are subject to the service users living together in harmony. The users did not arrive all at once and the Registered Provider has done as much as possible to ensure that the later arrivals would fit in with the others already living there. This was done through pre-placement visits and the obtaining of full information prior to admission. Problems have presented themselves relating to one service user dominating and bullying others this has now reached a point where their placement cannot be sustained. Staff have intervened by counselling and referral to other agencies. Staff are also aware of subjects that are emotive and upsetting to individual users and are quick to change conversational tack when this occurs. Standard 17 (17.1 ­ 17.9) The registered person promotes service users health and wellbeing by ensuring the supply of nutritious, varied, balanced and attractively presented meals in a congenial setting and at flexible times. 3 Key findings/Evidence Standard met? The Inspector ate lunch with two service users, a visiting parent and the Registered Provider and her deputy manager. The lunch was prepared in the kitchen jointly by a member of staff and a service user, individual likes and dislikes were observed and the meal was eaten in the dining area or in the lounge, the whole experience was enhanced by the homely atmosphere that prevails at Little Arches. The new service user ate in The Cottage as a matter of choice; prior to eating she had prepared lunch assisted by another member of staff. Meals are a regular item of discussion and users are encouraged to state their preferences and follow through by shopping for them and preparing them in the kitchen at Little Arches.Little ArchesPage 18 Personal and Healthcare SupportThe intended outcomes for the following set of standards are: · · · · 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 homes 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.Standard 18 (18.1 ­ 18.11) Staff provide sensitive and flexible personal support and nursing care to maximise service users privacy, dignity, independence and control over their lives. 3 Key findings/Evidence Standard met? All service users at Little Arches require personal support and guidance on a daily basis as their assessed needs reflect their primary assessment of `learning disability. In some cases there are additional needs including physical disability or a manageable medical condition. Staff are trained in the administration of any additional medication pathways other than by mouth and also work closely with physiotherapists and others in delivering programmes aimed at overcoming problems such as limited mobility. All four service users have a history of mental health problems; staff liaise successfully with other agencies in dealing with this. Examples of work in this area were seen during the inspection and in each case the user has benefited.Little ArchesPage 19 Standard 19 (19.1 ­ 19.5) The registered person ensures that the healthcare needs of service users are assessed and recognised and that procedures are in place to address them. No. of incidents where service users have been taken to Accident & Emergency during last 12 months No. of service users with pressure sores at the time of inspection (from information taken from care notes) Key findings/Evidence Standard met? 00 3All service users are registered with a General Practitioner and are able to attend the health centre if necessary. Staff accompany on these occasions. In the past different users have required smear tests, scans, a course of diabetic injections, blood monitoring, and dietary and nutrition monitoring. Whenever any of these health interventions have required a visit away from Little Arches the staff have accompanied and transported the service user. Other health services such as dental, ophthalmic are available in the wider community with staff accompanying service users to appointments. Standard 20 (20.1 ­ 20.14) The registered manager and staff encourage and support service users to retain, administer and control their own medication, within a risk management framework, and comply with the homes policy and procedure for the receipt, recording, storage, handling, administration and disposal of medicines. 0 Key findings/Evidence Standard met? Not assessed on this inspectionStandard 21 (21.1 ­ 21.8) The registered manager and staff deal with the ageing, illness and death of a service user with sensitivity and respect. 3 Key findings/Evidence Standard met? The manager has looked at the making of Wills by service users and has introduced the subject to service users. All illnesses are treated at Little Arches whenever possible, hospital admission would only take place if recommended by a General practitionerLittle ArchesPage 20 Concerns, Complaints and ProtectionThe intended outcomes for the following set of standards are: · · Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm.Standard 22 (22.1 ­ 22.7) The registered person ensures that there is a clear and effective complaints procedure, which includes the stages of, and timescales for, the process and that service users know how and to whom to complain. No. of complaints made to the home during last 12 months No. of these complaints fully substantiated No. of these complaints partly substantiated No. of these complaints not substantiated No. of these complaints not yet resolved No. of complaints sent direct to CSCI Percentage of complaints responded to within 28 days Key findings/Evidence 0 0 0 0 0 0 0 Standard met? 3No complaints have been recorded or received since the home opened. Each service user is provided with a copy of the homes complaints procedure, although it is in written form it also uses the `smiley faces pictures to explain the concept of happy or unhappy to the users and assist them in understanding the purpose of the procedure. Relatives are also provided with a copy of the complaints procedure and are positively encouraged to bring any concerns to the attention of staff. One parent commented that when they had expressed concern to staff the matter was dealt with quickly and satisfactorily.Little ArchesPage 21 Standard 23 (23.1 ­ 23. 6) The registered person ensures that service users are safeguarded from physical, financial or material, psychological or sexual abuse, neglect, discriminatory abuse or self harm, or inhuman or degrading treatment, through deliberate intent, negligence or ignorance, in accordance with written policy. The home has an Adult Protection procedure (including Whistle Blowing) which complies with the Public Disclosure Act 1998 and the DOH Guidance No Secrets No of staff referred for inclusion on POCA/POVA lists Key findings/Evidence YES0 Standard met? 3The Rotherham MBC Adult Protection procedure is kept at the home. The inspector found that this procedure is included for staff going through induction training. It was established that any placing agency would expect the home to use the Rotherham MBC policy and guidelines in the case of any referral relating to abuse of a vulnerable adult. Since the deterioration in one service users behaviour the Registered Provider made a notification to Sheffield social services directorate that two other service users placed by that local authority were art risk of abuse from a third person placed by them.Little ArchesPage 22 EnvironmentThe intended outcomes for the following set of standards are: · · · · · · · 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.Standard 24 (24.1 ­ 24.13) The homes premises are suitable for its stated purpose; accessible, safe and well maintained; meet service users individual and collective needs in a comfortable and homely way; and have been designed with reference to relevant guidance. 3 Key findings/Evidence Standard met? Little Arches is a detached property in its own grounds in a residential area not far from Rotherham town centre. The area has plenty of local facilities, such as a park, shops, takeaways and a main bus route. The house is only entered after ringing a bell located on the outside wall next to a full-length gate that is kept locked; the wall is full height. When the gate is opened the visitor must go through a lockable conservatory that is pleasantly furnished and into the kitchen that again has a lockable door. Inside there is a dining room that is also used for craft and hobby work, a spacious lounge and three bedrooms on the first floor plus a bathroom and toilet, with a sleeping in room on the second floor of the building. There is a second toilet and shower downstairs. The adjacent garage has been successfully converted into a self-contained single bed unit with its own lounge, kitchen, bedroom and bathroom.Little ArchesPage 23 Standard 25 (25.1 ­ 25. 11) The registered person provides each service user with a bedroom, which has useable floor space sufficient to meet individual needs and lifestyles. Total no. of single bedrooms with at least 10 sq.m usable space or additional compensatory space Pre-existing homes only (1st April 2003) ­ single bedrooms below 10 sq.m usable space or additional compensatory space Total no. of wheelchair users accommodated for in rooms at least 12 sq.m Total no. of wheelchair users accommodated for in rooms less than 12 sq.m Total no. of shared rooms at least 16 sq.m Total no. of shared rooms below 16 sq.m Percentage of places within single rooms: 100 80 - 99 Less than 80 Total no. of single bedrooms Number of single bedrooms with en suite Total no. of double bedrooms Number of double rooms with en suite Key findings/Evidence YES NO NO 4 0 0 0 Standard met? 3 4 00 0 0 0All service users enjoy private accommodation in single bedrooms that are furnished and decorated to their liking. They share a bathroom and also have access to a second toilet and shower. The communal space meets the requirements of this standardLittle ArchesPage 24 Standard 26 (26.1 ­ 26.4) The registered person provides each service user with a bedroom that has furniture and fittings sufficient and suitable to meet individual needs and lifestyles. Key findings/Evidence Standard met? 3Each service user has provided a number of personal items of furniture that accompanied them at the time of their arrival at Little Arches. These items have all been listed and a record is kept on the users personal file. It was clear to the inspector from the invitations extended by the users to inspect their private accommodation that they were proud and satisfied with the way in which their rooms were equipped and laid out. All users had personal items such as soft toys, photographs, trinkets, toiletries and knick knacks on display in a manner decided by them Standard 27 (27.1 ­ 27.6) The registered person provides service users with toilet and bathroom facilities which meet their assessed needs and offer sufficient personal privacy. 3 Key findings/Evidence Standard met? The home provides a bathroom, 2 shower facilities and 2 toilets that meet the assessed needs of the service users accommodated here. The Cottage annexe provides a toilet, hand basin and shower.Standard 28 (28.1 ­ 28.3) A range of comfortable, safe and fully accessible shared spaces is provided both for shared activities and for private use. 3 Key findings/Evidence Standard met? Internally the home provides a dining area and spacious lounge as well as a domestic style kitchen. This is added to by a conservatory that comfortably seats 4 people and an outside patio area that is large enough to use for sitting out during the warmer months. The Cottage annexe is self-contained and other service users only have access to that property by invitation from the service user accommodated there.Little ArchesPage 25 Standard 29 ( 29.1 ­ 29.8) The registered person ensures the provision of environmental adaptations and disability equipment necessary to meet the homes stated purpose and the individually assessed needs of all service users. 3 Key findings/Evidence Standard met? Internally the home provides a stair-lift, a swivel bather, handrails, and grab rails in the toilet. External ramps make access to the patio area easier. Grab rails are provided where appropriate in the bathroom in The Cottage annexe.Standard 30 (30.1 ­ 30.9) The premises are kept clean, hygienic and free from offensive odours throughout and systems are in place to control the spread of infection, in accordance with relevant legislation, published professional guidance and the purpose of the home. 3 Key findings/Evidence Standard met? A tour of both premises including both private and communal areas found the home to be clean and in a good state of repair. Bathrooms, toilet and kitchen areas were free of offensive odours and cleaning routines promote the required level of hygiene.Little ArchesPage 26 StaffingThe intended outcomes for the following set of standards are: · · · · · · 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 homes 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.Standard 31 (31.1 ­ 31.7) The registered manager ensures that staff have clearly defined job descriptions and understand their own and others roles and responsibilities. 3 Key findings/Evidence Standard met? All employees are provided with a job description, contract of employment including their terms and conditions. Mrs Briggs has a deputy acting for her in her absence and between them they undertake the responsibility of organising and managing the other staff members. As the staff team (which includes Mrs Briggs) frequently work alone with the service users it is crucial that they each understand their duties and responsibilities. The inspector has met all of the staff employed at Little Arches and is confident that they are all aware of their duties in the day to day operation of the home; this awareness is underpinned by the provision of a `help file containing all the necessary information regarding what agencies/people to contact with regard to problems with the premises, utilities or service users. Standard 32 (32.1 ­ 32.6) Staff have the competencies and qualities required to meet service users needs and achieve Sector Skills Council workforce strategy targets within the required timescales. 3 Key findings/Evidence Standard met? The staff team provide a ratio of 1:4 throughout the day and night with additional staff on duty as required for trips, reviews, appointments etc. Mrs Briggs and one other staff member have NVQ level 2 or above, one staff has just commenced their Level 2 training and one other has yet to start. The service user who is planned to leave in the near future has a 1:1 ratio of staffing at the present time.Little ArchesPage 27 Standard 33 (33.1 ­ 33.11) The home has an effective staff team with sufficient numbers and complementary skills to support service users assessed needs at all times. Staff numbers/hours relating to the needs of service users are based on guidance recommended by the Department of Health. Personal Care No. service users High needs No. service users Medium needs No. service users Low needs Total no. of hours needed No. of staff with NVQ level 2 or above No. of Trainees registered on Sector Skills Council training programme Key findings/Evidence 1 3 0 155 3 No. of full time equivalent Staff with nursing qualification (where applicable) No. staff hours allocated No. staff hours allocated No. staff hours allocated Total Hours Provided 54 120 X 174 Nursing X X X00Standard met?3The staff team provide a ratio of 2:4 during the waking day; one service user currently has 1:1 during the waking day. Others are dealt with on a 1:3 ratio throughout the day with additional staff on duty as required for trips, reviews, appointments etc. At night one member of staff sleeps in. Mrs Briggs and two other staff members have NVQ level 2 or above, two other staff have commenced their Level 2 training. Standard 34 (34.1 - 34. 8) The registered person operates a thorough recruitment procedure based on equal opportunities and ensuring the protection of service users. 3 Key findings/Evidence Standard met? The Inspector met a newly recruited member of staff and saw their references and Criminal Record Bureau check. Their employment process included being interviewed by service users.Little ArchesPage 28 Standard 35 (35.1 - 35.8) The registered person ensures that there is a staff training and development programme which meets the Sector Skills Council workforce training targets and ensures staff fulfil the aims of the home and meet the changing needs of service users. 3 Key findings/Evidence Standard met? Doncaster college are the accredited training agency providing the National Vocational Qualification level 2 training for staff at Little Arches.Standard 36 (36.1 - 36.8) Staff receive the support and supervision they need to carry out their jobs. Key findings/Evidence Standard met?3Support is available for all staff during the working week either from Mrs Briggs or her deputy manager. Supervision is provided on a minimum 3 monthly basis and this standard was being metLittle ArchesPage 29 Conduct and Management of the HomeThe intended outcomes for the following set of standards are: · · · · · · · 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 homes policies and procedures. Service users rights and best interests are safeguarded by the homes 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.Standard 37 (37.1 ­ 37.4) The registered manager is qualified, competent and experienced to run the home and meet its stated purpose, aims and objectives. Registered manager qualified to level 4 NVQ in Management and care [by 2005]. Key findings/Evidence NO 2Standard met?Mrs Briggs holds a Technical Instructor qualification that allowed her to work alongside Occupational Therapy staff at a hospital day centre for patients with learning disabilities for a number of years. She also holds the NNEB nursery nursing qualification, obtained after 3 years of study. Mrs Briggs has now identified a training provider to help her acquire the NVQ level 4 in Management qualification.Standard 38 (38.1 ­ 38.6) The management approach of the home creates an open, positive and inclusive atmosphere. 3 Key findings/Evidence Standard met? Staff observed during this inspection visit and on a previous visit are comfortable with the management approach of Mrs Briggs. All staff appear comfortable with the atmosphere in the home and their level of including each other and service users in observations, decisions and opinions is good.Little ArchesPage 30 Standard 39 (39.1 ­ 39.10) Effective quality assurance and quality monitoring systems, based on seeking the views of service users, are in place to measure success in achieving the aims, objectives and statement of purpose of the home. 3 Key findings/Evidence Standard met? Quality assurance and monitoring take place in the home with regular service user satisfaction surveys by interview both privately with individuals and collectively at meetings and spontaneously during meals, quiet times etc. Reviews attended by family and advocates and visits by relatives are also used to establish satisfaction with the care delivered. Review records showed that placing agencies and families are satisfied with the care provided at Little Arches. Standards 40 (40.1 ­ 40.6) The homes written policies and procedures comply with current legislation and recognised professional standards, covering the topics set out in Appendix 2 of the National Minimum Standards for Adults (18-65). 3 Key findings/Evidence Standard met? Policies and procedures provided for staff by Mrs Briggs are available for all of the topics set out in Appendix 3.Standard 41 (41.1 ­ 41.3) Records required by regulation for the protection of service users and for the effective and efficient running of the business are maintained, up to date and accurate. 3 Key findings/Evidence Standard met ? Previous discussion with Mrs Briggs found that although the service users possess some literacy skills the present `Access to files and record policy would not fully meet the intention of such policy as the files and records are kept in written form and no user has sufficient skills to fully comprehend them although assistance by their keyworker is offered with all literacy tasks. A variety of symbols are now in use to enable service users to express their satisfaction or dissatisfaction with different elements of their care. Each service user now has a photographic record of their achievements, accomplishments and newly learned skills in addition to the usual photo album of recreational events. The `achievements record graphically illustrates the progress made by individuals at the home.Little ArchesPage 31 Standard 42 (42.1 ­ 42.9) The registered manager ensures so far as is reasonably practicable the health, safety and welfare of service users and staff. 3 Key findings/Evidence Standard met? Through induction training at the point of employment and through policy and guidance available to all staff the health, safety and welfare of service users and staff is promoted. All service users are assessed regarding their response to the fire safety evacuation procedure. Records show that food hygiene practices are carried out as required as are COSHH regulations with written risk assesment records. The staff are trained in moving and handling, fire safety, first aid including choking risk procedures, food hygiene and infection control. Service records for the stair lift were up to date. Standard 43 (43.1 ­ 43.7 ) The overall management of the service (within or external to the home) ensures the effectiveness, financial viability and accountability of the home. 2 Key findings/Evidence Standard met ? Mrs Briggs has previously shown the inspector her annual business statement as provided by her accountant, this statement confirmed that the business was financially viable. An up to date statement will be sent to the Inspector.Little ArchesPage 32 PART C(where applicable) Condition CommentsCOMPLIANCE WITH CONDITIONSComplianceCondition CommentsComplianceCondition CommentsComplianceCondition CommentsComplianceRegulatory Inspector Second Inspector Regulation Manager DatePeter Burkinshaw Janet WilkinsonSignature Signature SignaturePublic reports It should be noted that all CSCI inspection reports are public documents. Little Arches Page 33 PART DD.1PROVIDERS RESPONSE TO IDENTIFIED STATUTORY REQUIREMENTSRegistered Persons comments/confirmation relating to the content and accuracy of the report for the above inspection.We would welcome comments on the content of this report relating to the Inspection conducted on 10th August 2004 and any factual inaccuracies: Please limit your comments to one side of A4 if possibleAction taken by the CSCI in response to provider comments: Little Arches Page 34 Amendments to the report were necessaryNOComments were received from the provider Provider comments/factual amendments were incorporated into the final inspection report Provider comments are available on file at the Area Office but have not been incorporated into the final inspection report. The inspector believes the report to be factually accurateNONONONote: In instances where there is a major difference of view between the Inspector and the Registered Provider both views will be made available on request to the Area Office. You will also note that the Commission has identified in the inspection report good practice recommendations and it would be useful to have some indication as to whether you intend to take any action to progress these. Status of the Providers Action Plan at time of publication of the final inspection report: Action plan was required YESAction plan was received at the point of publicationYESAction plan covers all the statutory requirements in a timely fashion Action plan did not cover all the statutory requirements and required further discussion Provider has declined to provide an action planYESOther: enter details here Little ArchesPage 35 D.3PROVIDERS AGREEMENT Registered Persons statement of agreement/comments: Please complete the relevant section that applies.D.3.1 I, Mrs Andrea Briggs of Little Arches, confirm that the contents of this report are a fair and accurate representation of the facts relating to the inspection conducted on the 10th August 2004 and that I agree with the requirements made and will seek to comply with these. Print Name Signature Designation Date Or D.3.2 I, Mrs Andrea Briggs of Little Arches, am unable to confirm that the contents of this report are a fair and accurate representation of the facts relating to the inspection conducted on the 10th August 2004 for the following reasons:Print Name Signature Designation Date Note: In instance where there is a profound difference of view between the Inspector and the Registered Provider both views will be reported. Please attach any extra pages, as applicable.Little ArchesPage 36 Little Arches / 10th August 2004Commission for Social Care Inspection 33 Greycoat Street London SW1P 2QF Telephone: 020 7979 2000 Fax: 020 7979 2111 National Enquiry Line: 0845 015 0120 www.csci.org.ukS0000003135.V147649.R01© This report may only be used in its entirety. 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