Inspection on 30/11/06 for Little Ingestre

This inspection was carried out on 30th November 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Little Ingestre 18/06/08

Little Ingestre 17/01/06

Little Ingestre 29/09/05

Little Ingestre 23/03/05

Little Ingestre 07/01/05

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Little Ingestre Ingestre Park Near Great Haywood Stafford Staffordshire ST18 0RE Lead Inspector Ms Wendy Jones Key Unannounced Inspection 30 November and 01 December 2006 14:00 Little Ingestre DS0000004973.V312734.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 Little Ingestre DS0000004973.V312734.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. Little Ingestre DS0000004973.V312734.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Little Ingestre Address Ingestre Park Near Great Haywood Stafford Staffordshire ST18 0RE 01889 270410 F/P 01889 270410 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) Platinum care Homes Ltd Mrs Alison Jane Giles Care Home 15 Category(ies) of Learning disability (3), Physical disability (15) registration, with number of places Little Ingestre DS0000004973.V312734.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 1 Service user over the age of 65 years Date of last inspection Brief Description of the Service: Little Ingestre is registered to care for 15 younger adults with physical disabilities including 3 who may have associated learning disability. The home is managed by Platinum Care Homes, based in Wolverhampton. Little Ingestre has been established for 20 years and many of the residents have lived there for a long time. The home caters for people with a range of disabilities, including visual impairment, epilepsy, cerebral palsy and head injury. The home is originally part of the Little Ingestre Estate and has extensive and well laid out gardens. The property has been extended over the years and provides 13 single bedrooms, 6 with en-suite facilities and 2 double rooms, both with en-suite facilities. In addition there are assisted bathing facilities and adequate numbers of toilet facilities on both floors. A new shower room has been added to the ground floor. There are two lounge/dining areas on the ground floor, one smaller and quieter than the other. The home is situated in a rural setting on the outskirts of Great Haywood, Nr. Stafford. Access is via on un-adopted road. The home does not currently have access to a mini bus, consequently there is a reliance on staff vehicles and taxi transport to access the community and attend appointments. Two residents have their own transport, via mobility payments. The current range of fees was recorded as £370 to £890 per week. Little Ingestre DS0000004973.V312734.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection carried out over a four day period, from the initial planning and discussion to the inspection visit and feedback session, but excluding the writing of this report. The methodology-included collection of pre inspection information, such as residents, relatives, GP and social worker questionnaires, and information provided by the manager; examination of information received in response to the previous visit and a fire officer’s visit and the outcomes of two complaints. The inspection visit included discussion with the manager and the deputy, interviews of two staff, interviews with three residents and conversation with other residents and staff; examination of care and staff records, policies and procedures and other relevant documentation; and a tour of the environment. What the service does well: Relatives comments included “much improvements over the last few years, very pleasant atmosphere”, “very satisfied with the care and service my relative receives”, “always made very welcome”. A social worker stated, “I have found Little Ingestre and the staff to be very helpful when looking at placing a resident. I always feel they communicate any changes promptly”. In resident pre inspection feedback comments included,” I volunteered to move into this home”, “ I like living here and feel safe”, “I can make decisions about my life”. The home provides a good quality service to residents, they confirmed that they are included in the day-to-day decisions in the home and are able to discuss choices regarding their preferred routines and lifestyles. Resident’s views are regularly audited through quality audit reviews, at meetings or on a daily basis. Staff are trained to a good standard and provided in sufficient numbers to meet the needs of the residents. The manager and her deputy provide a good level of leadership and have an understanding of the National Minimum Standards for the service. The health and safety of residents is assured by sound policies and procedures, good standards of record keeping and compliance with relevant regulations. Little Ingestre DS0000004973.V312734.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: 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. Little Ingestre DS0000004973.V312734.R01.S.doc Version 5.2 Page 7 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 Little Ingestre DS0000004973.V312734.R01.S.doc Version 5.2 Page 8 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): 1, 2, 3, 4,and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents and their representatives have the information needed to choose a home, which will meet their needs. They have their needs assessed and a contract which clearly tells them about the service the will receive. EVIDENCE: As part of this inspection the quality of information given to people about the care home was looked at. People who use the service were also spoken to, to see if they could understand this information and how it helped them to make choices. The information included the service user’s guide (sometimes called a brochure or prospectus), statement of terms and conditions (also known as contracts of care) and the complaints procedure. A copy of the Statement of Purpose received from the manager is in a format not considered to be user friendly, this was discussed during the inspection. The manager stated that the Service User Guide has been produced in a userfriendly format and it is the intention of the service to produce the Statement of Purpose in this form. In addition there are plans to produce both documents and any relevant policies and procedures in Braille and to dictate then on the audiotape for the benefit of service users with a sensory impairment. Little Ingestre DS0000004973.V312734.R01.S.doc Version 5.2 Page 9 Assessment information relating to existing residents is in place, there is evidence that the manager undertakes her own pre admission assessment. She stated that her practise is to ensure that she and another member of staff go out to undertake the assessments of prospective residents, it was also clear from the information available on individual files, that the service ensures that it receives any professional/social worker assessment for the individual. During this visit we discussed the admission of residents on a respite basis this has been discussed at previous inspection visits and a requirement made for an application for a variation to the CSCI. It was established that this variation could not be made, as there isn’t a registration category for respite care. We discussed the rationale for admitting someone on a respite basis into this environment. The manager felt that if the admission is part of a planned transition to the home with the intention of a permanent placement, it is appropriate. This has been agreed in principle, if the service could evidence that other residents have been consulted and the Statement of Purpose reflects this. At the time of the visit, a resident was residing at the home on a respite basis. The record of pre admission assessment indicated that the residents’ needs could be met and she said “I like it here”. The manager stated that any prospective permanent resident is encouraged to visit the home prior to making a decision to move in and is expected to have introductory visits, the period of time, over which this is organised, can vary for each individual. The service is registered for Younger Adults, which means adults between the age of 18 and 65 years, previously a variation to the registration has been made for one individual who is now over that age. Information provided states that a second resident is also over 65 years of age. A variation to the current registration is to be agreed. Little Ingestre DS0000004973.V312734.R01.S.doc Version 5.2 Page 10 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, 8, 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individuals are involved in decisions about their lives, and play an active role in planning the care and support they receive. EVIDENCE: Samples of 5 care files were looked at during this visit. They contain assessments of need; care plans and risk assessment relating to that need. There is evidence that residents have been consulted about their care and in some examples have signed their care plans to confirm that they agreed with them. The service undertakes 6 monthly formal reviews of care with individual residents. The records show that quite often the only attendees at these reviews were the residents, the manager or deputy. It is recommended that where possible the service establish with the resident who else they may wish to be involved in these reviews. It was recognised that some residents may not wish any one else to be involved. Little Ingestre DS0000004973.V312734.R01.S.doc Version 5.2 Page 11 The service uses some generic plans that they personalise for the individual, in some examples, these have not been properly individualised, these matters were discussed with the manager. There is evidence of monthly evaluations of care plans and risk assessments; a 24 hours plan of care is also produced in symbol form and simple language. The manager discussed the planned introduction of a Person Centred model of care; she said that some residents had chosen to retain the current care planning arrangements. 3 residents were interviewed during this visit, and conversations occurred with another 5. Residents said that they are involved in care planning and are happy with the level of decision-making they have. They said they were involved in monthly residents meeting and all knew who their key worker was. The manager said that residents chose their own key workers. The records of residents meetings showed that they have been held on a regular basis and the topics of discussion have included planned and chosen activities, menu selection and issues arising in the home. Little Ingestre DS0000004973.V312734.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15,16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use services are able to make choices about their life style, and supported to develop their life skills. Social, educational, cultural and recreational activities meet individual’s expectations. EVIDENCE: Monthly residents meetings are held; the records showed that residents are involved in discussing meal choices, activities, outings and other matters. This visit did not include a detailed inspection of all areas, but following discussion with residents it was established that individual arrangements were made for activities. Examples included one resident who made arrangements to go to a local bingo session in a nearby village, and told me of other occasions when she went out to visit friends and former colleagues. Little Ingestre DS0000004973.V312734.R01.S.doc Version 5.2 Page 13 One resident discussed that how he enjoyed a range of hobbies and interests and is supported by the service to engage in these. Another resident discussed how his time is spent engaging in activities that he found interesting but often chose to not be involved with planned activities in the home. One resident has their own Personal computer and discussed how he uses it to keep in touch with friends and relatives; another uses a typewriter to write letters and communicate with his family. Another resident with a visual impairment has specialised equipment to enable her to communicate effectively. The deputy manager stated that residents are offered a range of activities in the home. An activity worker has been employed to facilitate these. During the visit, residents were observed to engage individually in activities that staff knew they enjoyed, one resident was typing a letter to his family, one resident was drawing, another was listening to music, others were engaged in conversation with care workers. One member of staff stated that she felt the range and frequency of activities in the home could be improved further. Residents who have a visual impairment attend a club that is run by the Royal National Institute for the Blind and also receive regular publications and newsletters from this group. I was told that residents also receive talking books and newspapers. The spiritual needs of residents are records in care plans and where identified residents are supported to attend religious services, there were no residents of a ethnic minority or requiring specific cultural needs to be addressed. Policies on Equality and Diversity are available in the home. The manager said that 4 residents have been on holiday with their respective families, other residents have not, although outings can be arranged on an individual basis. Residents don’t have access to snack or drink making facilities in the home but individuals do have fridges in their rooms. I was informed that access to drinks is not limited and is available on request. In the residents meeting minutes, it showed that residents have agreed to plan a fortnightly menu that is to be rolled over for a 4 week period, before changes are to be made again. Residents said that the food they have is satisfactory and that they are offered choices to the main meal at every mealtime. The manager stated that the cook is asked to ascertain resident’s satisfaction with the quality of the food provided on a daily basis. In addition she undertakes a monthly audit to ensure that residents are receiving the choices and quality of food they want. None of the current residents require a special diet or have specific cultural dietary needs. I did not observe a mealtime during this visit. I was informed that all staff have received Basic Food Hygiene training this was confirmed by the two staff interviewed during this visit. Little Ingestre DS0000004973.V312734.R01.S.doc Version 5.2 Page 14 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 and 21. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. EVIDENCE: The pre inspection questionnaire indicates that one resident has a pressure sore and receives input from the district nurse approximately 3 or 4 times per week. The manager stated that there has been a significant improvement in the condition of the sore. Three service users are identified as having a high dependency, six of medium dependency and three of low dependency. Six residents are wheelchair dependent, others user them occasionally. Since the last inspection 1 resident has been admitted to hospital via the accident and emergency department and one reportable incident has occurred in the home. Little Ingestre DS0000004973.V312734.R01.S.doc Version 5.2 Page 15 I was told that two residents are registered blind and one is registered partially sighted, the service does not have the registration category for sight impairment and must apply for this category. From discussion, the specific needs of service users with a visual impairment appeared to have been met, there was a range of specialist equipment used by at least on individual, I was told that residents received talking books and newspapers, that one resident who used Braille received information in this form. The manager discussed how she intended to improve matters further by dictating relevant information onto audio tape. One resident has been referred to a dietician for advice, and there was evidence that other health professionals had been contacted in the past where necessary. The manager stated that all staff have been trained in basic foot and nail care by the Chiropody services, and Epilepsy awareness training is planned for January 2007. She also confirmed that residents receive regular eye tests and staff have also received some training from the ophthalmic company providing this service. Speech therapy input has also been accessed in the past. A minority of residents smoke, the home has allocated an area in the laundry, away from the main communal areas in the home for them to do this. Two residents have been provided with adaptations to enable them to retain relative independence in this area, although they are supervised. Records showed that residents are supported to access health services and appointments for regular health checks as required. The GP stated that she felt that the home provides a good service to the residents, (in the pre inspection questionnaire). In the health related plans and risk assessments there is evidence of good practice, regular reviews and resident involvement. In one risk assessment for the use of the hoist, the risk assessment did not include the specific hoist or strap to be used; this was discussed with the manager for her action. In another example the plan for bathing a resident should be more specific. Specialised equipment such as hoists, beds and adaptations are provided, and individuals are assessed for mobility aids such as wheelchairs, walking aids and other equipment. Medication: All staff who administer medication have completed a certificated training course and have received training from the pharmacist who dispenses the medication. A monitored dose system is used; this means that medication is sealed in a container, which indicates the day, and time the medication should be given. The medication is stored in a locked trolley that is secured to the wall. Medication that is required to be stored as a controlled drug is stored in a separate locked facility within this trolley, and the records relating to it’s Little Ingestre DS0000004973.V312734.R01.S.doc Version 5.2 Page 16 administration are appropriately maintained. The Misuse of Drugs(Safe Custody) Regulations 1973 provides information regarding the storage of controlled medication and indicates that a review of the current storage arrangements must be undertaken. The manager stated that, all staff must undertake an assessment of competence following the medication training. This will be repeated annually. There was evidence that some medication was being either dispensed from it’s original container or given to a relative when residents went on outings or on leave for a period. The practice of secondary dispensing was discussed with the deputy manager who stated that a separate medication form is completed with clear instruction about the medication and when and how it should be administered, this is checked with the original instructions and both the person dispensing the medication and the person receiving it check and sign to confirm accuracy. Ideally secondary dispensing should not occur, but it understood that this can limit the spontaneity of outings and events. The general rule of thumb is understood to be 1) where the outing or activity is planned the service should approach the dispensing pharmacy to provide the required supply in a suitable container. 2) when the outing or activity is unplanned the service must have robust procedures in place for checking, recording and dispensing the medication. The records relating to the receipt, administration and return of medication were appropriately maintained in the home. With the exception that on occasions a code was not used to explain why medication had not been given. None of the current residents in this home self medicate. Residents records included their wishes in the event of their death if known, some had families who had made arrangements on their behalf. We discussed the rights of residents to have their wishes respected in relation to their estate. Little Ingestre DS0000004973.V312734.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are able to express their concerns, and have access to a robust, effective complaints procedure, are protected from abuse, and have their rights protected. EVIDENCE: A complaints procedure is available in the home, and has been produced in a user-friendly form, the manager stated that she will be looking at other methods of producing this information to ensure that all service users can access it. Since the last inspection two complaints have been made to the Commission for Social Care Inspection, the areas of concern included personal care issues, restriction on the rights of service users and abusive behaviour towards service users. One complaint was not upheld and one was partially upheld, the provider demonstrated that appropriate action has been taken to ensure that the matters have been resolved to the satisfaction of the complainant. All three residents interviewed during this visit, gave accounts of how they would make a complaint if they needed to and all felt that the service reacted appropriately to any matters they have raised in the past. They all spoke positively about the support they have received from the manager and the staff. Little Ingestre DS0000004973.V312734.R01.S.doc Version 5.2 Page 18 During this visit, the manager discussed an alleged abusive situation that was being discussed through multi disciplinary meetings to protect the resident. The evidence from this visit was that the manager and staff are familiar with the Vulnerable Adults procedures agreed locally; know what constitutes abuse and how to report it. Both staff interviewed confirmed that they have received guidance in recognising and reporting abuse. The manager stated that all staff have received this training during their induction period and provided evidence that an additional training session had taken place on 23 November 2006. Little Ingestre DS0000004973.V312734.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides a physical environment that mostly meets the specific needs of the residents who live there. The home is comfortable, and has a rolling programme to improve the decoration, fixtures and fittings. Residents can personalise their rooms. They also say that the home is clean, warm, well lit and there is usually sufficient hot water. There has been some consultation with service users about the décor, especially for their own rooms. Some ensuite facilities are available. EVIDENCE: A programme of refurbishment has taken place since May 06 and electrical work attended to as identified at previous inspections. Further work is planned to continue to improve the environment for residents, including new flooring and décor. One resident stated that she would like her bedroom to be redecorated; this information was passed to the manager. Little Ingestre DS0000004973.V312734.R01.S.doc Version 5.2 Page 20 The home provides adequate communal space in two lounge dining rooms, one has been fitted with new flooring, and the other room is carpeted, but shows evidence of staining. The manager stated that the rolling programme of refurbishment includes a plan to replace the flooring in this room. Two bedrooms are doubles and both have en-suite facilities, as do a number, but not all of the single bedrooms. Some of the single rooms are also not as spacious as others and would not meet the minimum spatial requirements required for a new service. One resident showed how she had to reverse her wheelchair into her bedroom because of the restriction in the width of the room. It was recommended that, if a larger bedroom becomes available this resident is given the opportunity to change her room, if she chooses to. A sample of other bedrooms shows that residents have been supported to personalise them, with evidence of family memorabilia, memento’s and photographs, evidence of hobbies and interests, some residents have their own telephone, all had televisions and radio’s. One resident discussed his love of music and films. All bedroom doors where fitted with locks, those residents who chose to had a key to their room. The provider is committed to a rolling programme of refurbishment, which includes fitting radiator guards to protect residents from the risk presented by high surface temperature of radiators. One resident wasn’t happy about this and complained the guard on a radiator outside his room, caused him problems when he was accessing or exiting his room, due it’s bulk. This matter was discussed with the resident and the manager, and a review should be undertaken to provide a solution that protects residents but does not impact of this residents lifestyle. It was suggested a low surface temperature radiator could be fitted. Access to the first floor of the home is via two staircases, the home does not have a shaft or stair lift, making this area inaccessible to service users who’s mobility is impaired. The manager confirmed that only independently mobile service users have bedrooms on the first floor. The laundry area on the ground floor provides ample space, a sluice and sufficient laundry equipment, the manager stated that phase 2 of the refurbishment programme will include improvements in this area. The home is located in a rural area and is set in pleasant gardens, with a fish pond and well established shrubs, lawns and flower beds. Little Ingestre DS0000004973.V312734.R01.S.doc Version 5.2 Page 21 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): 31, 32, 33, 34, 35 and 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service ensures that all staff receive relevant training that is targeted and focussed on improving outcomes for residents. The service uses external providers to deliver this training if they have not got the appropriate skills within the organisation. There is a good recruitment procedure that clearly defines the process to be followed. This procedure is followed in practice with the service recognising the importance of effective recruitment procedures in the delivery of good quality services and for the protection of individuals. People who use the service are regularly involved in the recruitment process. EVIDENCE: The pre inspection questionnaire indicates that the service provides 607 hours per week including 40 hours for the manager. The actual hours include: 30 hours cook, 16 hrs activities assistant, 23 hours domestic, 40 maintenance, and 372 care hours. Little Ingestre DS0000004973.V312734.R01.S.doc Version 5.2 Page 22 13 staff are employed, 11 of whom are reported to have NVQ level 2 or above, which exceeds the minimum standard of 50 of the workforce. All staff are reported to have undertaken first aid training, either at emergency first aid level or at a higher level. All staff are reported to have received mandatory training. Three staff have left since the last inspection by the Commission for Social Care Inspection, one of who was dismissed. Four staff has been recruited, the latest recruit joined the team in May 2006. Two of the care staff have been interviewed during this visit, both confirm that they have received a good and detailed induction, were undertaking NVQ 2 training, have received 1:1 supervision on a regular basis and have undertaken all mandatory training. The manager stated that staff supervision is scheduled approximately every 8 weeks. The manager, deputy and senior carers divide responsibility between them, the manager said they have all received training, but were waiting for updates. A sample of 3 recruitments records were looked at, confirming that the procedures adopted by the service are robust and in keeping with current expectations and good practice, in that there was evidence of two written references, Criminal Records Bureau checks, application forms, health statements and forms of identity. All have a copy of a job description on the file and the two staff interviewed confirmed that they have signed their copy. All records include terms and conditions of employment that stipulated the hours of work and the salary scale. In all the files there is evidence that residents views had been considered at interview. Record of staff meetings showed they were held regularly, staff confirmed this. Little Ingestre DS0000004973.V312734.R01.S.doc Version 5.2 Page 23 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a strong ethos of being open and transparent in all areas of running of the home. The manager is person centred in her approach, and leads and supports a strong staff team who have been recruited and trained to a good standard. The manager is aware of current developments both nationally and by CSCI and plans the service accordingly. EVIDENCE: The manager and deputy stated that they are undertaking a National Vocational Qualification (NVQ) in care at level 4, the manager also said that she would be enrolling on the Registered Care Managers Award once she has completed the National Vocational Qualification. Little Ingestre DS0000004973.V312734.R01.S.doc Version 5.2 Page 24 Since the last inspection a fire officer has visited the home and made some recommendations to ensure that the service complies with current fire safety regulations. The report was discussed at a pre inspection visit and the manager has responded in writing confirming that all matters had been addressed. Issues had included, a number of fire resisting doors that did not fully self-close, were ill fitting within their frames or had ineffective cold smoke seals. The recommended fitting of a automatic release system for both lounges and the bedroom doors opposite the main lounges. All staircases must be free of combustible storage and potential ignition sources. The door to the “twin” bedroom should always be available to be used and not locked. In addition the external corridor door adjacent to the main Lounge should always be easily and immediately opened from the inside without the use of a key. A fire blanket and extinguisher should be provided in the kitchen. Fire records show that fire drills have been undertaken regularly, regular checks of fire fighting equipment, fire alarms and emergency lighting are also undertaken and records maintained. Monthly fire door checks have been included in the routine schedule of fire safety checks. The manager stated that a full evacuation of the home has been conducted since the last inspection. Annual fire training is due at the end of February 2007 and health and safety training took place 02 October 2006. The information in the pre inspection questionnaire indicates that all maintenance and servicing of equipment in the home has been completed. All policies and procedures have been reviewed since 10/05. Quality audits are carried out regularly. The records show that food audits are carried out monthly, views of residents, relatives, social workers and health professionals are sought approximately every 3 months. The manager stated that as a result of feedback, one room in the home had been redecorated. Little Ingestre DS0000004973.V312734.R01.S.doc Version 5.2 Page 25 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 3 2 3 3 2 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 2 26 X 27 X 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 4 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 3 3 X 3 X 3 3 X Little Ingestre DS0000004973.V312734.R01.S.doc Version 5.2 Page 26 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. 2 Standard YA20 YA1 Regulation 13(2) Care Standards Act 17 Requirement Controlled medication must be stored in a suitable container. A variation to the registration of the service must be applied for to include 3 persons within the Sight impairment category. Medication records must show why medication is not administered by recording a description of the code used The policy and procedure for medication should be revised to provide clear guidance on secondary dispensing and where possible avoid it. Timescale for action 30/01/07 30/12/06 3 YA20 30/12/06 4 YA20 13(2) 30/01/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA24 Good Practice Recommendations The manager should take action to reduce the potential rip hazard created by the inspection hatch on the ramp DS0000004973.V312734.R01.S.doc Version 5.2 Page 27 Little Ingestre outside the ground floor shower room. 2. YA3 Ensure that if residents are to be admitted for respite care, that there is evidence the home can meet their needs, that other residents have been consulted and that there is an intention to consider the placement as permanent. Give further thought to supporting the resident to invite other interested parties to their care reviews if they want to. Ensure that care plans are resident specific. Resolve the problem identified by a resident caused by the radiator guard located in the corridor outside his bedroom. The manager should complete the National Vocational Qualification in care at level 4 and enrol and complete the Registered Care Managers Award. 3. 4. 5. 6 YA6 YA6 YA24 YA37 Little Ingestre DS0000004973.V312734.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES 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. 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