Inspection on 01/08/07 for Longridge Court

This inspection was carried out on 1st August 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Longridge Court 20/07/08

Longridge Court 02/05/06

Longridge Court 29/09/05

Longridge Court 04/04/05

Longridge Court 12/10/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Longridge Court Bull`s Cross Stroud Gloucestershire GL6 7HU Lead Inspector Ms Lynne Bennett Key Unannounced Inspection 1 & 9th August 2007 10:15 st 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 DS0000060822.V336586.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. DS0000060822.V336586.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Longridge Court Address Bull`s Cross Stroud Gloucestershire GL6 7HU 01823 814341 01452 810712 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) Voyage Limited To be appointed Care Home 14 Category(ies) of Learning disability (14), Physical disability (14) registration, with number of places DS0000060822.V336586.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th January 2007 Brief Description of the Service: Longridge Court was first registered in July 2004 to provide accommodation to 14 service users with a learning and/or physical disability in two separate dwellings. It has since been refitted to provide additional accommodation for up to three people in a self contained flat. It is owned and managed by Voyage Ltd. People living in the main house may have high care needs, such as wheelchair dependence, auditory and visual impairment, autistic spectrum disorder or epilepsy. People living in Almartom (the annexe) may have additional low level challenging behaviour. People living at The View (the flat) may have a learning disability and associated challenging behaviour. Situated near to the village of Painswick, Longridge Court is in a rural location and has easy access to the neighbouring towns of Stroud, Cirencester and Gloucester. 7 people live in the main house and 3 people may live in the flat. Almartom accommodates 3 people. (This has been reduced from the initial registration for 4). All three residences are self-contained with single rooms that have en-suite facilities. The house has a lounge, music room and dining room, whereas the other residences have a combined lounge/diner. Almartom has a sensory room. There are substantial grounds around the property. People living at the home have access to three vehicles. The fees at the home range from £1,412 to £1,746. The Statement of Purpose and Service User Guide are displayed in the hallway to the main house, further copies are available from the office. DS0000060822.V336586.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. This inspection took place in August 2007 and included site visits to the home on the 1st and 9th August. The manager was present for the second visit. The care of three people was examined in depth, this included observing them and talking to them and staff about the service they receive. Nine comment cards were returned from parents or relatives of people living at the home. The annual quality assurance assessment was not supplied to us prior to the inspection. The manager was in the process of completing this and said that it would be returned as quickly as possible. A range of records were examined which included care plans, medication and financial records, staff files, health and safety information and quality assurance systems. What the service does well: What has improved since the last inspection? Admission procedures are more comprehensive ensuring that assessments and care plans are obtained prior to placement. Staff have received training in the use of ‘as necessary’ medication. Environmental issues identified at the last inspection were dealt with including replacing a person’s carpet in their room and redecorating the annexe. DS0000060822.V336586.R01.S.doc Version 5.2 Page 6 Night staff have received fire, medication and moving and handling training. 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. DS0000060822.V336586.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 DS0000060822.V336586.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): 2 and 5. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People have access to the information they need which is regularly reviewed enabling them to make a decision about whether they wish to live at the home. An assessment of their needs and wishes are taken into consideration before offering them a place. EVIDENCE: Since the last inspection major alterations have been made to the first floor of the main house to provide separate accommodation for up to three people. The flat called ‘The View’ has three en suite rooms and a communal lounge, dining area and kitchen. There is also a small office. Two people have moved into the flat. Both were transferred from other homes belonging to Voyage. Their files confirmed that they had been assessed by Voyage prior to moving into Longridge Court. These documents were supported by an assessment and care plan from their placing authority. Records were kept of all visits to the home and of visits to people at their former placements. Staff confirmed that they had worked with one person at their former placement. Staff from a home that was closing supported a person during their initial period at Longridge Court. Three-month placement reviews have been scheduled. Both people said they have settled into their new home DS0000060822.V336586.R01.S.doc Version 5.2 Page 9 People have a copy of the Service User Guide on their files and copies of the contracts between themselves, the home and their placing authority are in place. However there was no evidence of a copy of the statement of terms and conditions between themselves and Voyage. DS0000060822.V336586.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 and 9. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Greater consistency in care planning will ensure that the assessed and changing needs of people are identified and they are safeguarded from possible harm. EVIDENCE: The care for three people was examined in depth and the care for others sampled. One person from each residence was chosen. This involved reading their care plans and examining their medical and financial records, talking or observing them during the visits and talking to staff about the care they provide. Each person has a care plan in place that provides a holistic assessment of his or her physical, intellectual, social and emotional needs. Those examined clearly relate to assessment of needs and care plans supplied by their placing authorities. Key workers monitor care plans each month providing a written record of any changes in need and an analysis of the care each person has received. It was DS0000060822.V336586.R01.S.doc Version 5.2 Page 11 evident that where changes are noted plans and risk assessments are changed accordingly. For instance concerns had been raised about the behaviour of one person and after a multi disciplinary meeting several actions were identified including investigations into their health and changing ways of communicating with the person. There was evidence to confirm that these had been put in place and plans were being changed to reflect this. Daily records indicated that the level of challenging behaviour had significantly reduced and the person was much calmer. Staff confirmed that although care plans are no longer being reviewed every three months, the monthly summaries provide the opportunity for review if needed. Care plans were being reviewed every twelve months at the time of the person’s annual review with their placing authority. The manager confirmed that comprehensive care plan reviews were in place to take into account positive changes for people living at the home. Some placing authorities had also supplied copies of their care plans. Through case tracking one person it became evident that they can at times become extremely agitated. There were several documents giving staff information about how to support them in the management of their anxieties and listing solutions. Their care plans and risk assessments however did not refer to these. Another person has a sleep system in place for which there are monitoring sheets in their room. Again their care plans and risk assessments did not refer to the use of this system or the reasons for it. Risk assessments are in place minimising hazards identified in care plans. One person’s risk assessment identified that they are at risk of scalding. Water temperature records for their bathroom indicated that the temperature in June was 50°Centigrade and no action was taken to resolve this. Few restrictions are in place in the home. Due to the vulnerability of people living in the main house they have limited access to the communal garden and windows and doors within their home overlooking the garden are kept shut. This restricts their freedom of movement and to ventilation within their home. The manager has recognised the need to divide the garden to provide two separate areas for each residence. Fencing has been purchased and had partially been put in place at the time of the second visit. The home has a missing person’s policy and procedure in place but does not have a missing person’s file providing individual pen pictures and a photograph which could be used in the case of an emergency. Most information about people living at the home is stored securely in locked offices. Fluid monitoring charts for several people are displayed in the dining area of the main home making this information accessible to visitors. DS0000060822.V336586.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): 12,13,14,15,16 and 17. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staffing levels impact on the availability of appropriate activities for people living at the home reducing opportunities to engage in social, recreational and therapeutic activities. A reduction in the budgets for provisions may impact on the nutritional content of people’s diets. EVIDENCE: Each person has an activity schedule in place that indicates a range of opportunities for social, educational and leisure activities during the week. Daily diaries were sampled for a two-week period. For two people they indicated that they were able to follow their schedules participating in work experience opportunities at a charity shop and farm, trips out to local towns, helping out at a local church, going to hydrotherapy or to a local cafe. For other people there appeared to be less consistency with some activities not taking place such as horse riding and swimming. Staff said that any cancellations would be due to inadequate staffing levels. Some people living at DS0000060822.V336586.R01.S.doc Version 5.2 Page 13 the home have 1:1 support and this appears to be maintained at all times. Staff indicated that this has a knock on effect for people living in the main house who may find some of their staff have been redeployed to another residence and they are unable to go out. During the first visit to the home, most of the people in the house and annexe were at home for the day. One person briefly went shopping. Two people helped to prepare meals; others were in front of the television or in the garden. Rotas indicated that two staff work in the annexe and two in the flat with a minimum of four staff working in the main house. The rota for the house and annexe over a two-week period indicated that staffing levels fluctuated between 4 and 7 per shift. (Also see Standard 33) Comments from parents and a relative indicated that there should be ‘ higher levels of staffing, sufficient transport to carry out activities and structured activities for daytime, evenings and weekends’ and ‘activities have been sparce due to lack of staff and transport’. The manager said that due to people going on holiday, staff holidays and managers holiday considerable strain had been put on the rota during July and August. She admitted that this had been a scheduling error. She also said that due to recent flooding locally the summer ‘day service’ they had planned to use had been postponed until the end of August and had impacted on scheduled activities for people. She said that an activity co-ordinator had been appointed to take responsibility for organising people’s schedules. She stated that the quiet lounge was being refurbished to provide art and craft, computer and music sessions for people. People will have access to a new music therapist and massage sessions continue to be arranged for people at home. Several people attend college during term time and had signed up to attend a summer school that had unfortunately been cancelled at the time of the visits. Staff are supporting one person to do a paper-round and to find appropriate work experience. People have regular contact with their families. One person was going home at the time of the visit. Comments from parents and relatives confirmed that they are made welcome when visiting the home. Some people maintain contact over the telephone. One parent said that there should be ‘an effective answer phone service in place’ and access to email for people living at the home. People have the opportunity to help with meal preparation, recycling, gardening, cleaning and their laundry where appropriate. People in the flat are encouraged to be as independent as possible and were observed helping to prepare a meal. Two people living in the main house were also involved in meal preparation. Rooms have keypads and some people were observed accessing their rooms using these, others require the support of staff. DS0000060822.V336586.R01.S.doc Version 5.2 Page 14 There is a four-week roll over menu plan that is followed by staff. People are offered alternatives to the main meal. People in the main house require support from staff to eat their meals. Their care plans provide guidelines for staff. They were observed feeding people at their pace and interacting positively with people during their meal. Meals are nutritious in content with a range of fresh ingredients being used. The manager confirmed that people will be involved in shopping for the provisions for the home. Concerns were raised about a recent decrease in budgets for food resulting in a reduction in the quality of the meals being produced. It was felt that this was impacting on the quality and availability of food. Budgets were examined confirming that in February 2007 there was a reduction of over £300 per month in the provisions budget. This has not been increased when additional people moved into the home or additional staff have been employed. Budgets indicated that the provisions budget is overspent each month. Whilst examining financial records several receipts were noted for meals out. In the space of one week, a person paid for three meals out which were replacements for meals provided at the home. Staff commented that they had been told that they were taking people out for too many meals and that a picnic lunch could be provided when people were going out on an activity such as swimming or horse riding which over lapped with a mealtime. DS0000060822.V336586.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Inconsistent monitoring of people’s healthcare appointments may affect the health and wellbeing of people living at the home. Improvements must be made to the administration of medication to ensure that people are safeguarded from possible harm. EVIDENCE: Care plans give staff information about the way in which people would like to be supported with their personal and healthcare needs. Each person’s individuality is respected and they are supported to dress in a way that reflects their personal interests and lifestyles. Staff finish their shifts at 8.00 pm and waking night staff take over with one person sleeping in. Staff confirmed that people do not go to bed before this time unless they wish to. A letter from one person’s occupational therapist indicates that they like to go to bed at 8.00 pm to watch their television for an hour before falling asleep. DS0000060822.V336586.R01.S.doc Version 5.2 Page 16 A range of specialist equipment and adaptations are provided for people’s use. People have access to support from healthcare professionals including the local Community Learning Disability Team. There was evidence of prompt referral to the team. One person is supported to use their lite writer, a communication aid. Photographs are also used to illustrate one person’s daily activities and a staff rota. Staff were observed using objects of reference i.e. a jug of orange juice or squash, to give choice to people. New people moving to the home have been registered with a doctor in Gloucester and arrangements were being made between their former Community Learning Disability Team and the local team for continued support. Other people are registered with the local surgery. Healthcare records are maintained which give a record of the outcome of each appointment. Dental records for one person indicated that an appointment was overdue. This was arranged during the visit. Comments from a parent indicated this is an ongoing problem. ‘Dental care has room for improvement’. People are supported to attend outpatient appointments. One parent commented that ‘we were informed immediately when our daughter was admitted as an emergency to hospital’ and ‘following this, the staff support during the 5 day stay at hospital was second to none’. Medication administration systems were inspected. Staff receive training in the safe handling of medication. Two medication errors were reported to us in the past six months. Preventative action was taken as a result of this and the manager confirmed that issues were addressed with staff. Gaps were noted in the administration records in two of the residences. Staff explained the procedure for checking that medication has been taken and said that the next person on duty would normally have highlighted any gaps. Handwritten entries on some records were being countersigned but this is not consistent practice. Liquids, creams and eardrops are mostly labelled with the date of opening. One cream dispensed in February 2007 was not labelled and staff were advised that this would need to be replaced. A liquid in the main house was also not labelled but others were. The temperature is being recorded for medication kept in the main house but not in the other residences. The manager confirmed that homely remedies are not being used by the home. The copy of the British National Formula dated September 2004 needs to be replaced. DS0000060822.V336586.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. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Some people have concerns about the effectiveness of the complaints procedure in addressing issues they have identified. Systems are in place to protect people from possible harm. EVIDENCE: The home has a complaints policy and procedure that is displayed around the home. It is also produced in a symbol and text version. A folder is kept in the main office. Several compliments had been received but no complaints. Two new people who have moved into the home and one other person said they would talk to staff or the manager if they had any concerns. Relatives of one person have had ongoing concerns about staffing levels and access to activities. They feel that Milbury/Voyage have still not addressed these issues. This inspection confirms those ongoing concerns. The home has a copy of ‘No Secrets’ and the Gloucestershire Adults At Risk procedure. Staff spoken to explained what they would look out for in cases of suspected abuse and what they would do if they had concerns. Not all staff were aware of the whistle blowing policy and procedure. Staff confirmed that they have access to training in Crisis and Aggression Limitation Management (CALM). Clear protocols are in place for three people stating that physical intervention is used as a last resort. Staff confirmed that they use diversion and distraction effectively. Staff were observed guiding one person, living in the annexe, away from a situation which may have resulted in DS0000060822.V336586.R01.S.doc Version 5.2 Page 18 either harm to them or others. They were observed doing this on several occasions. There was no protocol in place for this person. The finances for the three people being case tracked were examined. Receipts were kept for all expenditure and could be cross-referenced with the records. Balances are checked regularly and signed by staff as correct. Bank statements are also in place, although there was no evidence that these were being checked. DS0000060822.V336586.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, 29 and 30. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People live in a home that is safe, clean and well maintained which recognises their diverse needs creating an environment that matches their personal requirements. Specialist equipment is provided to those people who need it. EVIDENCE: Longridge Court provides purpose built accommodation for people with a physical disability. Access throughout the ground floor of the main house and annexe (Almartom) is level and corridors and doorways provide sufficient space for people who use wheelchairs. All rooms have en suites that include a bath and/or shower. Overhead tracking is supplied to en suites in the main house. Other specialist adaptations have been put in place after consultation with occupational therapists. People have been supplied with easy chairs that specifically meet their needs. They were observed using these during the visits. Daily diaries confirmed there regular use. DS0000060822.V336586.R01.S.doc Version 5.2 Page 20 Communal areas have been pleasantly decorated and people are personalising them with their own pictures and photographs. The training kitchen has been converted into an office. The systems for day to day maintenance has recently changed. There was evidence that staff are requesting repairs to the home and these are being actioned. There was a recent flood in the main house (due to an overflowing bath) and staff reported that carpets that were sodden had an unpleasant odour for a while. The carpets had an unpleasant odour and there were signs of water damage to the ceiling. The manager confirmed that measurements have been taken and that quotes would be obtained. At the time of the visits the home was clean and tidy. Hazardous products are stored appropriately and staff have access to personal protective equipment. Staff have access to infection control training. DS0000060822.V336586.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): 32,33,34, 35 and 36. People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staffing levels severely restrict the ability of the home to deliver person centred support and the availability of training may adversely affect the health and welfare of people at the home. EVIDENCE: There has been some stability to the staff team over the past twelve months. New staff confirmed that they were working through their induction programme. Milbury/Voyage has produced a booklet that follows the Common Induction Standards. Staff said that they then register for their NVQ Awards in Health and Social Care. Six staff have completed a NVQ Award and six staff were completing their awards. Concerns have been raised both by parents and staff about whether current staffing levels were appropriate for the needs of people living at the home. It appears that when there were problems maintaining staff levels at the flat or the annexe staff from the main house were relocated to these residences leaving the main house with reduced numbers of staff. At the time of the visit there were three staff vacancies including two waking night positions, which DS0000060822.V336586.R01.S.doc Version 5.2 Page 22 were being covered by the staff team. The home was not using agency staff to supplement this. There are currently two bank members of staff. Files were examined for five new members of staff and there was evidence that recruitment and selection procedures meet with the requirements of the Care Homes Legislation. Copies of Criminal Record Bureau checks were in place. A training matrix was in place for April 2007 that indicated there were continuing shortfalls in access to training for staff. Staff confirmed that they have had training in fire and the administration of midazolam. Records confirmed that of the staff group one person has a current moving and handling certificate, four people have a current first aid certificate and eight people have completed food hygiene training. Staff said that they have been supplied with open learning packages for mandatory training and that a staff member would be responsible for delivering this. The manager confirmed that this training would not be completed until the trainer had received the necessary training. The manager has accessed some training locally to train staff as trainers in moving and handling. There is an outstanding requirement in relation to this. Action may be taken by the Commission as a result. DS0000060822.V336586.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 and 42. People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The quality of the service provided to people living at the home is being affected by the organisation’s failure to ensure vital systems are maintained. EVIDENCE: The manager has considerable experience working with people with a learning disability. She has completed her registered managers award and NVQ Level 4 in Care. She has been confirmed by the Commission as the registered manager for the home. Staff and parents spoke highly of her professionalism and managerial skills. Some comments indicated that ‘local managers are not given the staff and resources to meet the needs of residents’ and ‘her appointment as manager was an excellent move’. The manager has a clear developmental plan for the home but is hindered by organisational constraints DS0000060822.V336586.R01.S.doc Version 5.2 Page 24 such as cutting provisions budgets, access to activities, staffing levels and access to mandatory training for staff. Milbury/Voyage have a quality assurance system in place that involves unannounced visits by the operations manager each month. This involves speaking to or observing the care of one person living at the home each month. An annual quality assurance report is produced. The manager is introducing house meetings which will involve people living at the home and staff. Feedback from their parents and relatives will be obtained from key workers prior to these meetings. There are processes in place to monitor health and safety around the home. During the visit the fire alarm was tested as part of the weekly system of checks and recorded in the appropriate file. It did not appear that testing was taking place each month for emergency lighting. Water temperatures were being tested regularly although there was no evidence that where these were recorded outside safe parameters that any action was being taken. Portable appliance testing of all electrical equipment is presently being completed. There was evidence that regular checks were being carried out on bedsides. Similarly records for fridges and freezers and cooked food temperatures were being maintained. Good practice was observed in fridges with food being labelled with the date of opening or preparation. DS0000060822.V336586.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 X 2 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 1 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 2 2 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 2 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 3 X 3 X X 3 X DS0000060822.V336586.R01.S.doc Version 5.2 Page 26 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA5 Regulation 5(1)(ba) Requirement Timescale for action 01/11/07 2. YA7 3. YA9 4. YA10 5. YA14 6. 7. YA17 YA19 People must be provided with a statement in respect of accommodation and personal care and any additional costs to them. 23(2)(a)(o)(p) People must have access to gardens that they can use safely and be able to have adequate ventilation in rooms that are used by them. 13(4) Hot water outlets within the home must be assessed for the risk they present to people and action taken to minimise any identified risk. 17(1)(b) Information about people must be stored securely and not shared with visitors to the home promoting their right to confidentiality. 16(2)(m)(n) People who live in the home must be assisted to participate in a programme of activities that reflect their social interests. 16(2)(i) People must be provided food that sustains a nutritional and healthy diet. 13(1)(b) People must have access to regular dental appointments. DS0000060822.V336586.R01.S.doc 01/09/07 01/09/07 01/09/07 01/09/07 01/09/07 01/09/07 Version 5.2 Page 27 8. YA20 13(2) Medication must be administered to people in a safe manner, ensuring that homely remedies have been authorised by the doctor, medication records are completed correctly and a current BNF is obtained. Where staff guide or physically move a person to prevent harm to them or others, guidance must be provided to state when it is appropriate to use such intervention. Water damage to the ceiling and carpets needs to made good minimising the risk of infection and ensuring the environment is kept in a good state of repair. The numbers of staff working in all parts of the home must be sufficient to meet the needs of the people ensuring that the service they receive is not affected due to staff shortages. Food Hygiene training and other mandatory training must be provided for all staff who work in the home. This requirement has been repeated from the last two inspections. 01/11/07 9. YA23 13(7) 01/11/07 10. YA24 223(2)(b) 01/12/07 11. YA33 18(1)(a) 01/11/07 12. YA35 18(1)(a) 01/11/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations DS0000060822.V336586.R01.S.doc Version 5.2 Page 28 1. 2. 3. 4. 5. 6. YA6 YA9 YA20 YA23 YA23 YA42 Care plans and risk assessments should refer to any guidelines and management plans which are in place. A missing person’s file should be put in place which would provide information about each person which could be supplied to police in the case of an emergency. Temperatures should be recorded for medication cabinets to ensure that medication is being stored within safe parameters. Staff need to be aware of the whistle blowing policy and procedure. Bank statements should be checked with financial records to ensure that no discrepancies are occurring. Emergency lighting should be tested each month to ensure it is in good working order. DS0000060822.V336586.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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